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F R FFICE USE: __- f ------�.-_ (- APPLICATION FOR SANITATION PERMIT Permit No. .. _. --.. -------------------- ---- --- --------------------------- (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 appliciifion is made in compliance with County Ordinance No. 549. �/ JOB ADDRESS AND LOCATION I ;145 ---------- ' ---. -' � "�- =---------------------------------------•-------•-----------•----..-.. ------------ Owner's Name------------ Phone--�r---_l-----_--:�-- ��" Address...... sast... �e.�--- _ Contractor's Name... ----..._/ Gt r� ' 1-----_t r—Q -:._ ---------- ------•-- ----- Phone-_x1 � ----------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms _2Number of baths __�-_ Lot size �o._-___.. _________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _e!_ 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 ❑ No NL FHA/VA: Yes ❑ No) TYPE OF INSTALLATION AND SPE1004CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TTank�-r Distance from nearest well-----------------Distance from foundation___________________Material---_____.-----_-_--_- ..___--------___ ❑ —t No.. of compartments-- --- -------------------Size--------------------------------Liquid depth-------------------:------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_________________ ❑ eNumber of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- length----------------._._.--------------------- V1 Seepage Pit: Distance to nearest well�l.�t�___Distance from foundation-----,l:�---!----.Distance to nearest lot line___.'------- 6 Number of its------ ,�f s Depth---------1Z- .--•---------.--- p' �_________.__Lining material___ !z=/�_..Size: Diameter____._ ..____,_ Cesspool: Distance from nearest well--------- ------Distance from foundation------------- -__-.Lining material-------------------------------------- 01 ❑ Size: Diameter--------------------------------------Depth---•------------------------------------------------Liquid Capacity---------------------------•gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_____________.._______________..___--.._. ❑ Distance to nearest lot line--------- -------- --- ---------- ---------- - ----------------------------------------------------------------------------------------------- _ S Remodeling and/or repairing {describes__________ --A4---, - -� .,� __..mac �c�c, _--- z-___..__._________________________ ----------------•-•-----...__..-------- ----------------------•------------------------------------------------------------------------------------C/--------- ----/------------------------------------------------------- 0 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 41 -------------- ---------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)--------------------10-0-- -------- _- --_ - --------------------------------------------------------- �_ (Ow er and or ContractorgY:--------------------------- :� .---_��. �-------------------------------------_Title}- = ..... -- -------------- Plot Ian, showing size of lot, location of s ste in relation to wells, buildings, etc., can be laced on reverse side). ( P 9 Y 9 P } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = DATE = �,//_ -----e--�/--------------------- REVIEWED BY -•------------------------ -------------------------------- DATE BUILDING PERMIT ISSUED------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations: L�._l � 't- z -=s" ;---------.- ,� - R .�� -^ { k ' #-------------- r – - -----------------------------------------------------------------------------------------'----------------------------------------- --------------------------------------------------------------------- ^^ ----------- ---------------- -------------------------------------- -------I----------- >--------'------------------------ I 7 FINAL INSPECTION BY:----Art_ ------ -------------- Date------ ------�l-, t AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 4.59 3M 3-'63 F.P.CO.