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]-UK UI-FICE USE: ------------------- ----- -------- -------------------- ----------------------------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------- -------------- --------- ------------ (Complete in Duplicate) _ This Permit Ex fres i 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 CountyxOrdinance No. 549. JOB ADDRESS ANp _ 3x�__LOCATI N_. _ _ t 17 Owner's Name -- ------ f'r'y :_..,. , r ,,� ----------------- ----- Pone Address �_�..._ -------- ------•---------------------- Contractor's Name__ _ / �_ .13 Installation will serve: Residence ® Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other E]� I Number of living units: -1----- Number of bedrooms __�-- Number of baths _�___ Lot size _s�0q f'.;,��T,�'-__----,0-_,----_---_ Wafer Supply: Public system ❑ Community system ❑ PrivafeA Depth to Water Table �PO ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay [] Adobe ❑ Hardpan Fh' f Previous Application Made: (If yes,date_..._______________) No ❑ New Construction: Yes ❑ No E-1 FHA/VA: Yes ElN0 ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: =� -•(No-septic-Tank-or-cesspool permitted.if..public-sewer.is available.x4hin-200 feet.)..—_�-.r Septic Tank: Distance from nearest weliQ�----Distance from foundation___/__a_______ __Material-t �_ XNo. of compartments---1�-------------------Size-3-=`_1-y-_%r---:---Liquid depth------Y-------_--------Capacity Disposal Field: Distance from nearest well..4rl--------Distance from foundation---/P-----------Distance to nearest lot line---- Number of lines------Z---- ----- ------------- Length of each line-------�G--------------Width of trench----2, !' Type of filter material 4-104--f Depth of filter material_____d? '_._.__._Total length___f -j_ - -------------------- Seepage Pit: Distance to nearest well----/----_____Distance from undation----fh'.......Distance fo nearest lot line__4 ------ Numbsr of pits__-------_-------Lining maferial-/I- 1 -.--.Size: Diameter__._ --- -- Depth_ -------------------- -- . Cesspool: Distance from nearest well________________Distance from foundation-----_--------------Lining materia-------------------------------- _._._______-_________.._ - '�l --- - Size: Diameter --------------Depth---------------------------- --------- - - ------Liquid Capacity---------------------------gal` a 1 Privy: Distance from nearest well ---------------- _------------------------------Distance from nearest building -El l Distance to nearest lot line_________ ___________ ------------------------------------------------------------------- -------------------------------------- - - Remodeling and/or repairing (describe)________________________ � ------------------------------------------------------------------------------------------------------ ------------------------------------- --------------------------------------------- --------------------------------•------------------------------------------------------------------------.--------------- " ------------- ----------- ----------------- ------------------------------------------------------------------------ . I 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 regulations of the San Joaquin Local Health District. (Signed)------ -- ------ s ------------------ -----------------------------------------(Owner and/or Contractor) -------=_----• -------------- = == (Title)---- - ( ) _---- .._ �(Plof,plen_,Yshowing,size�f ,lot,ylocation of system in relation to welts, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ REVIEWED BY - ------------ DATE._ - -Ifz-- .......................... ----- ------------------------------------ ----- DATE- BUILDING UILDING PERMIT ISSUED-------------------------- - --------------------------------------------- DATE-- Alterations --------------------- ------------------------------- Aterations and/or recommendations:----------------------- ------------------- --------------------------------------------------------------- ••----------------------------- ------------------------- --------------- -------------- --------------------- ----- FINAL INSPECTION BY:_ Dafe.� _p �fa SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 O.