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1 , rc�1tJrrlCE USE: --- ------- --_-z Z--- --- - - - ---------------------- APPLICATION EOR"'SANITATION PERMIT Permit No. L------------------_ ------------ - ------------------ --- ---------------- (Complete in Duplicate) r P .--- This Permit Expires 1 Year From Date Issued Date issued �.�3-�� 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 Ordinan o. 549. JOB ADDRESS AND L TION---- ------ -------------- - - --- -- --------- - -- -- - ---------- f Owner's Name --------- - -•----•---------- { .— ------ -------------------- ----- -- Phone - Address-----•--------------,._ Contractor's Name -------- -----------------------------------•--- Phone7L% Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms 5/_ Number of baths _ ------ Lot size -------------- -S`D ' Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table 767- ft. Character of soil to a depth of 3 feet: Sana ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------------.---I No �k New Construction: Yes ET No X 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---------------_--_.__---......._.-____.......-.. 06c,6LAIC— No. of compartments...............____ .--...Li Liquid depin ----.Capacity ----Size---------- - --- ------- q P � ----------------------- Disposal Field: Distance from nearest well-.7s--------Distance from foundation.. ---------Distance to nearest lot line_A9--------- I Number of lines...[ — -_ _/_ -___Length of each line...,7.jF.�_-.Width of trench.-.�..`..............._.. 01 Type of,filter material-.- .. .Depth of filter material...- -_g.__.__-_..Total length___.-v_21S-- ------------------------ oe P Seepa a Pit: Disfance fo nearest well_lao--___._-___DistanceUojfkndation..,l.M---.._._.Distance to nearest lot line__-_...._Number of pits-_(LQ.(f�_Lining material--� Gfi'- Size: Diameter-------- --- t� Depth------- --------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter---- --------------- ------Qepth-------- ---------------------- - -- - ----- Liquid Capacity-- - - ------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.._____.....-.-..-.----__.-.-..-.-.------ ❑ Distance to nearest lot line-- ------ --------------------------------- --•-------- ---------------------------- Remodeling N ------------------------------------- ---------------------------- ` f Remodeling and/or repairing (describe):- --.- - ',,---------- -- - --- © -- - - -------------------------------- -- - ---------•----------------------- ------------------•----------------------------------------------------------------------------------------------------------------------------- ----------------------------- -. �. -------------------------------------- - ------------------------- ----------•---------------------------------------------------------------------------------------- - ------------•---------------------------- ------ a ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I herebmsixeo(fof, ha prepared thorelafion d that the wor ill be done in accordance with San Joaquin County ordinances, d rut s and regulaJoaquin Lo ealth District. (Signed) ---- - -{Owner and/or Contractor} BY:---- ------ -- ------------------- ---------------ITitle)------- (Plot plan, shot, location of syo wells, buildings, etc.,.can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- _~ ------------------------------------ DATE....... T- —3--=x:5-7 �. REVIEWEDBY--------------------------------------------- -------------------- ------------- ------ -------------------------------------- DATE-- ----- ---------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------ - - Alterations and/or recommendations-------- ------ --------------------------------------------------------------------------------------------------------•-------•----------------•-------------- --------•----------------------------- --------------•----------------- - - ------------------------------ ----------------------------------------------- -----I------ ---------------------------------------------------- ------------ --- -------------------------------------------------------------------------------------------------------------- ---------- ------------ ----------- -------------- ------------------------------------ FINAL INSPECTION BY:....- ------------------- Date-------- -- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.