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! ------------- ------- --------- APPLICATION FOR SANITATION PE j/ 'Fe ?y I �� S-f .. PERMIT Permit No. _f-_-�--•-r---- ------- 1 + t (Complete in Duplicate) J --- -'• ------- - ----------- --------- This Permit Expires 1 Year From Date Issued Date Issued ----_/l.------_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Fe�ein de�ib d.. This application is made in compliance with County O dinance No. 549 - PZJOB ADDRESS AND L A710N T- ---- ------0�'. -.-3-7---------------------- .-�_-tom^ ,/use' " a!!e s� Owner's Name----------- / j /1/ Cr"�ior -- Phone---- Address---------------_------- 7-------------- Contractor's Name------------- ' • --s-h�� ^-1--�------------ ------------ - ----------- ----------------- Phone.-- - - - - "�-`��--�..� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- ._ Number of bedrooms -- - Number of baths Lot size -------------------- Water Supply: Public system ❑ Community system ❑ Private Ej--tepth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [jj- Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date- --------------- No [�- New Construction: Yes ❑ No E3—FHA/VA: Yes ❑ No [5-- 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----------------------- Disposal Field: Distance from nearest well_, ----_--_Distance from foundation�Q____r-_.Distance to nearest lot line_00------------ Number of lines--------/--.__.-_-_ ___.__----Length of each line_ =�-�___----Width of trench_. '" g _ �V Type of filter material---_. 4►�,yr_Depth of filter material---/ '_-___-_____Total lengfih_-----, 7___-____---_ --------------- N Seepage Pit: Distance to nearest well__%1JB__---.___Distance fro foundation-- x!W-_-.-...Distance to nearest lot Number of pits__---._/-----------Lining material- _Size: Diameter-_. _ .......Depth.... ., '_---_-_----- .. . Cesspool: Distance from nearest well---_------._..--Distance from foundation___._.-----_-----_.Lining material...... _ .................. _._------ ❑ Size: Diameter---- --- ------ -�--------- Depth--- - --------------------------------------------Liquid Capacity...------------------------- gals. Privy: Distance from nearest well-------------------- .--- -.-___Distance from nearest buildin ❑ Distance to nearest lot line---------- ---------------------------------------------- Remodeling and/or repairing (describe):__. ___-*00--_--- ------------------------------------- - -. '� / ��- A /� -------------------------------------------•------------------------------------------------------ --------------- -------------- ------------------------ ------------------�p--------------------------------------------------------------------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State d rules and regulations of the San Joaquin Local Health District. f �.__, (Signed) �� ---------- - - ------- (0 er d/or Contractor) BY= (Title)------ - -- -� - - --- - (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY —.--------------------------------- DATE `f~{ C�Y BUILDING PERMIT ISSUED REVIEWED BY-�- ---------- - ------------ DATE------------------------------------------------- ---------- - DATE Alterations and or recommendations ------_..-s /� S �� -- ------ Z----�l<----- l FINAL INSPECTION BY:..-- �zi- - - Date-----------=-� -- --� � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.