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OFFICE' -- ----aUSE:�01Z_ - -- -`-- ! APPLICATION FOR SANITATION PERMIT Permit No. ------------------- --- ------------------------- -- ------------------- ---- ------------------------- 5 (Complete in Duplicate) Date Issued This permit Expires I Year From Date Issued ---------- Application is hereby made to the San Joaquin Local Health District Or a permit to construct and install the work herein described:.. This application is made in compliance with County Ordinance No..549.{ JOB ADDRESS AND LQCATION--- _ — -: `-------------------p---�----------`---•-- - -- ----- e�_ �_�Owner s Name---- _- -------- � - --- - ---- _ Phon Address----- ----------------- _.�..�..Z=, Q� .f t� _act - ----------------------- ...... Contractor's Name/X1 1- -. .__._ .1-- ..i------------------------=•------------------------------ -•---•------- ----------- Phone f6_C__F Z Installation will serve: Residence . Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other El , ,Number of living units: __j____'Num' ber of bedrooms _-`Number of baths I------ Lot size _6,9---.1-�t�_r__________------------ _____ � ' Wafer'Supply: Public system % Community system' ❑ Private ❑ Depth to Water Table !LOC ft. Character of soil to a depth of 3 feet: : Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ Adobe .Hardpan;❑ Previous Application Made: [If yes,date.._-.-_..,__.__._ } No New Construction: Yes E] No FHA/VA 'Yes ❑ NoX TYPE OF INSTALLATION fAND SPECIFICATIONS:-'; . [No sepfic tank or cesspool permitted i 'public sewer is available within 200 feet.] , # Septic Tank: Distance from nearest well----.--.---_.!___Distance from joundation__._,-....._--•--.Material----------- -.______^------ __---__._. ._.._. # ❑�y[LS No. of compartments------------ ------- -Size = Liquid.depth- = .Capacity - _ ,.. - i Disposal .Field: Distance-from nearest well-----------------Distance from foundation-_______.______:___:Distance to nearest lot line____:_____- [ ❑�'X`-5�(NCr Number of lines- ---------------------------------Length of each line-----------------------------.Width of trench.------:`______._ _._________-_-- f Type of filter material-------------------------Depth of filter material------------------ Total length_______.____=____:.. ' __________ Seepage Pit: Distance to nearest well_/ B_/1� _Distance am f ndation-_� .._____.Distance to nearest lot line- i Number of its _ - //_�� .-Size: Diameter_ f�_� _ De tn__ f . p �71,L_L�r.� Lining material p a�s7 Cesspool: Distance from nearest well_________________Distance from foundation---_----------------Lining material----_--------------------------------- 0 ___________._.______.._______.❑ Size: Diameter--- ---- -Depth----------------------------------------------------Liquid Capacity----------------------------gals. { --_------_Distance from nearest buildin Privy: Distance from nearest well----------------------------- ----- 9--------------------,-------------------- ❑ Distance to nearest lot line-- --- ------------------------------ - ---------•----------------• -------------------------------------------------------------------- ) o Remodeling and/or repairing (clescnibe):-- --- ----- ------- --------- - - ----------------------- ------------------------------------------------------------I------------------------------------------ ----------------------------------------------------- -----------------V---------------------------- ---------- --------------------_1------------------------------- -------------------------------•------------------------------- ---------------------------------• -------------------------,--------------------------------------------------------------------------------------------------- ___ i l I herebRe ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and r les and regulations of the San Joaquin Local Health District. (Signed)--------------- ------ --- - - Ls- �+ -------�. ------(Owner and/or Contractor) BY:-------------------------------------------#.--- �--i.�(-A.�---��--- - --- - � - ------------(Tif le)---- ----------(Ti+le)---- -- -------- --- - -------------�-. (Plot pian, showing size of lot, location of system in relation to we,Is, buildings, etc., can be pla on reverse side). A FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- a- ---- -- ------------------------------------------- DATE------- ;l `-------------------------- REVIEWEDBY--------------------------------- 1-------------- --------------------------- - ---------------------------------------- .. DATE---------------------------------------------------•------- BUILDINGPERMIT ISSUED--------------I----------------- ----- ----------------------------------- DATE---------------------•----------I---------------------------- Alterationsand/or recommendations:------------------------------------- ---------------------------- -------------------------=---•------------------- -•----•-•----------••------------- f ------------------------------------ - ------------------------------------------- ------ -- ---------------------------- ----- ------------------------- ------------------------------------------------------ I a_�, _ 6 r FINALINSPECTION BY:_. --•------ ------------------•---------------- Date-_..... --- ----- - ----- -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C4.