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FOR OFFICE USE: ,- ------------------------ ---------------- - ---------- APPLICATION FOR SANITATION PERMIT Permit No./fl__ -- ----- _____--:- --------`_-_.. . (Complete in Duplicate) Date Issued - -__------------------------------------------------ --- ` This Permit Expires 1 Year From 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 549, JOB ADDRESS AND LOCATION----- ------Ive ----------- - -------------------------------------------------Owner's Name t/ %�_ _l1f xf--------- - ---------= Phone_ffpAddress------------------------------` -- --- 1 -----.---------- ---------•-----------------------------------------------------.-------------------------------•-------- h ------ Contractor's Name----------- � +�. / 1 --e--� Phone..' . Installation will serve: Residence [A- Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms _--vNumber of baths __/_._ Lot size /,00---------------------------- - Water Supply: Public system OlCommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ©Clay E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------..Material--------------------_-------______.__._..____.__- ❑ No. of compartments-------------------------Size----------------------------:---Liquid depth---------------------_--Capacity----------------------- I ---Distance from foundation___ r — r Dispos�Field: Distance from nearest well-_-___`-____._ ,111-_-.___-.Distance to nearest.lot�ll..i``ne__S.---------- . ,. 0 Number of lines-' -----`-------- -------------Length of each line--- �-- ---------------Width of french..... --.Y``�_---.---------- Type of filter material--_��'__Depth of filter material__/,P _______Total length_______ ........._________________ Seepag ,Pit: Distance to nearest well----------'-__--Distance fro foundatlon---/'_�P-----__..Distance to nearest lot line____�_j_... 9 y Number of pits-- ---- -------Lining material--- 5WEv_e-Size: Diameter--_1--..............Depth ---------------- Cesspool: Distancefrom nearest well-----------------Distance from foundation--------------------Lining material----- ------------------------------- ❑ Size: Diameter- - = -`-------- -�-----------------Depth----------------------------- ----------------------Liquid Capacity-.------------------- gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----------------------------------------- F-1 Distance toy n a est lot line----- -------------- ----`--------------------------•----------------------------------------------- ------------- Remodeling and/or repairing (describe):I - ____.. ,_ ^-a�/ --- ------------ 1 !/Cf _____ �5<"✓_tet/______.___. .I x . -------------------------------------------------------------------------------------------------------------------------------------------------- ----- ----------------------------------------- ----- i ---------------------------------------------------------------I------------------------------------------------- ----------------------------------------------------------- -=--I --------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County ordinances, State rules and,regulations of the San Joaquin Local Health District. � r�.__`�. 17 ,� a �Y -�_--------- -------------------------- ------------ Owner and/or Contractor) (Signed)----------- ------------ - ._ kl' By: ------------------------------------------------- (Title - -G i (Plot plan, showing size of lot, locafton,6t system in relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- -------- ----------------------------------------------------- ----- DATE------------ `7 ----------------- REVIEWED BY---------------------------------- '"�'- ------------------------------------ -.--- DATE------------------------------------------------------------ ---- PERMIT ISSUED------------- y F -------------------------------------- DATE---- Alterations and/or recommendations: 9. �7_-_.�..�aA sy� -- ems_ ' _. zP.... - r.- --------------- --- ---='------------- ---------- ------- ----------- ---------------------- --------------------- ---------------------------- ------- ------------------------ I --------------------- -------------- INSPECTION BY: - Date ` �----------------------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. .300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ManteCar California Tracy,California J