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FOR OFFICE USE: � r �. _, t� -- - M , 6 S +_1__--_ 1_- APPLICATION FOR SANITATION PERMIT Permit No- ---------- ---------- -- -------------------------------- --- ----------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued . ___ 1...._-.___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made In compliance with County OrdinNor 549. -- — JOB ADDRESS AND L CATION / ----------- ----- 1------- --- � 16 �9Ca Owner's Name----------- `` '��f�lf ---------------------- ------ Phone----------------------•------------ Address--------------------- uk/io---....------------------------------•----- ---------------------------------------- ---------------•-----------------•------------ Contractor's Name----- _-;'-•- �C�- - ••----------------- Phone Installation will serve: Residence �Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: _ -?_. Number of bedrooms _- Number of baths _l_--- Lot size __.___.____---.-_._ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand m ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date----------- ---) No New Construction: Yesto ❑ FHA/VA: Yes 1]/1qo- ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta� Distance from nearest well-_-�---._Distant f om founclatior>/� __-___-.M (vial------C-��----a--- S� -- No. of compartments-- -Size-�-__��-_� �__._.1i Liquid' de th...______1_ Capacity __.____ ' Disposal Field: Distance from nearest well_____"_Distance from foundatio _.- - Q_-_____.Distance to nearest t line_5-- ----------- Q� (� Number of lines-------C----- -------------------Length of each lire------ ..(� ...-Width of french_! ;��--------------.--.�'l' Type of filter material._�/&�* __Depth of filter material...---�Q `�____-Total length---.,%`""�___�_____________________ See a e ` ( Dt � - -�______-De th__� 1 P g Sze. Diame e of lin . --/ . Distance to nearest.wellr_ _ __ _ _.-._Distance f m undation__________---_ Distance to nearest I r Number of pits-- ---------- -`----Lining e. material-- ) ,3 P ' .Cesspool- Distance from nearest well-----------------Distance from foundation-----.-..._.__.____.Lining material_.__.-___---------.__--_-_--_-_-.__ '. El Size: Diameter- -------------------------- - -De th----------------------------- -------------- ----Liquid Capacity_ -------------------- gals. �4 Privy. Distance from nearest well-------------- ---------------------------------Distance from nearest bui4ding-----------------_----________--.---..._. ' ❑ Distance to nearest lot line ----------------------- ---------- ------------------------t------- --------------•------- --------------------------------------------- a 11 Remodeling and/or repairing (describe):--------------- -- _ --------! -- --�-C-------- - -- ----------- ---------------------------• { ,n... 000 ------------------------ ------------`---------t----------- ------------- --------------------....-- I hereby cerfif that-I have prepared-this &jT0ication and "thief-theork will-be`dofid"in accordance with San Joaquin County ordinances, State ws and rules/ d regulations of the San Joaquin Local Health District. (Signed)---- -------- -_..__.--- - ------(Owner and/or Contractor) ---------- By:-------- 1 ----------------- ---------------------------------------------(Title)-------- . -- .------ ----. (Plot plan, showin ze of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- //'� �'"~- - DATE ----------------------f f� 4 REVIEWED BY-------------------------------- -- ------------ ----------------- ------------------------------ --------------------------- DATE-------- ------------------------------------------- ------ BUILDING ---- BUILDING PERMIT ISSUED-------------- :_ --�-------------------------- ATE----------------------------- �-------------------------- ----------------- � , Alterations and com endations:_--. _.-__'� =__l=fit_–: �: r'-" �' rt'-'t1- 'J�'--------- `{, - -- t. . --------------�--`---------=------ -------------------- f- -------------------------------------------------------------------------------------------------------------------------------------- -------------•----- ------------------------------------------------------- ---------------------------------- -----------------•-------------------- ------------------ ------------ --------------------------------- -------------•--------------------------------------------------------- - ------------------------------------------------------------------------- / ------- - Date_-------- -------------------------------------------- FINAL INSPECTION BY:._ .1.�'-_--.. __ --.-�'� _- AN,JOAQUIN LOCAL HEALTH DISTRICT f 1401 E.Hazelton Ave. 309 West Oak Street 124 Sycamore'Street 2.05 West 91h Street` Stockton,California Lodi,California Manteca,California Tracy,California.• F.F.0 O.