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'F' OFFICE USE: v /p ///!�' i- ------._ -_----._____---_ -------------/0...... ' APPLICATION FOR SANITATION PERMIT Permit No. ZM_-.--3-- ------------- ---------------- ------------------------ (Complete in Duplicate) -------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOC ION--- Owner's Name --------0 - � ------ !- --- -------------------- Phone..117-71-1- Address �Q__. --- ---- / �G�G ------------------------------------------ Contractor's L� .Apartment ❑ -------- Phonei� l�Q 7---- y.-- Installation will serve: Residence House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f "Number of bedrooms _.Number of bathsof size ----- ______________------- Wafer Supply: Public tsystem Community system ❑ Private ❑ Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam & Clay ❑ Adobe ❑ Hardpan ❑ Pp yes,dpte----- _..-r,__._-__) No,U New Construction: Yes El No [ FHA/VA: Yes -1NoR �r Previous Application- Made: -If 31 1 TYPE OF INSTALLATION AND SPECIFICATIOKS :1 $n _(No septic Tank or cesspool permifted',ifrpublic sewer is available within 200 feet.) 11 F v Septic Tank: Distance from nearest well+----------------Distance from foundation--------------- Material--------------------------------- --------------- `L ❑ No. of compartments------------ --- 5ize_..-----------------------------Liquid depth----------------- --------Capacity----------------------- Disposal Field: Distance from nearest well-__—..�.._.__Distance from foundation.-_.�4-_-----Distance to nearest lot line..�_�-� Number of lines--)--- ------- --- ---- j--------Length of each line-----��--'--------_---Width of french.'-_-r2- 4'------- -_- Type of filter mat rial... ' . � 4�_Depth.-ofXter.mai-erial--_,1091-1----- --_Total length..- -'-----______ ------ $eepage Pit: Distance fo nearest well.................. Distance frcyn foundation_- , .r_..Distance to nearest lot line-O? _'- l/ ._ ._..-. _ Number of pits-_--.../-_._-----.Lining material__-S}1 __Size: Diameter.3 Cesspool: Dis+ante from nearest well-----------------Distance from foundation---k--------- -..Lining material------------------------------------- - ❑ Size: Diameter----- -------------- ------------- -Depth-------------..------------- ------ Liquid Liquid Capacity. ;- gals. Privy: Distance from nearest well----------------- -..-.-.-._--..-......._._..----Distancelfrom.nearesf,building--------------------------------- ❑ Distance to nearest lot line----------------------- -----------c.-__-=-- _�!1 t - - Remodeling and/or repairing (descriE?e):-- -- -= ---- �/r1 -----------------------------•- -------------•- ------------------- ------------------------------------------------- ------------------------ ------------------------- -------------- ------------------------------I--------------------------------------------------------------------------------------------------- ------------ ---------- 1 hereby certify that I have prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, State laws and rules and 'rnoeafAons of the San JoaquinT"V. Health District. i (Signed) /r� / 1 _.. 5. caner 'a /or Contractor) By:--------- •--'------------------------- ---------------- ---- ------------------------------------ ---------------- (Title) f Pot plan,.showing.size'of lot, locat' of system in relation to wells, buildings, etc., can be placed on reverse side). . r" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - -- - -------- ---------------------- ---- -------------------- ---------- DATE-----------2- --3`-=----`�-�--- ------------- REVIEWED BY DATE ---------------------------- BUILDING PERMIT ISSUED ------------ ------------------- ----- ---------- DATE DATE-- ------------------------------- Alterations and/or recommendations--- -- ----------------- - ----------------------------------------------------------- ----------------------------------- -------------- ----------- --------- '` ------A°- - - ---------- ----- ---------------------------------------------------------------------------- ------------- --------------------- ---------------------------- ----------------------------- - ------- ------------------------------------------------ ----------------------- ------------------- -------------- ------ FINAL INSPECTION BY:........ ------------- ----------------------------- Date - ------`?=- ----��--- - ------ - ------------- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy, California f F.P.C o. s