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FOR OFFICE USE: - ----- c -- - _i--I-_-.."- APPLICATION FOR SANITATION PERMIT Permit No. --------- ----------- ------- -------- -------- --- (Complete in Duplicate} --- This Permit Ex ires I Year From Date Issued ,SPY LS ----- --------- ---------------------------------- Date issued _115P ---------- i is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein described. This application is made in compliance with County Ordinan No. 549. JOB ADDRESS AND LOCATION.�-_7/7- - C. -- - ---- ---- --------.................. ----- Owner's Nam 1i - --- - --------- •--------------------------------- 4 ----- --------- -- ---------- - -------- Phone Address 'A. - _- -------------------------------------------------- ----'-- ------•----••---.-•-----•--- Contractor's Name-- 75-..----•---- - - - --- ------------------------------------------------------------ Installation will server Residence,O'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1___-_ Number of bedrooms _Z__ Number of baths --_ Lot size -f O oC ata a Water Supply: Public system ❑ Community system ❑ Private 11 2--Depth to Water Table -�--.- ft. Character of soil to a.depfh of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date---_--------------- J No New Construction: Yes 2rNo ❑ 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 If --------Distance from foundation_1a- --------.Material No, of com artments_:_ oC_ c/' . p -- ---------- Size-----�----�� ----:---Liquid depth------ --- ! ,�.r�-- - Z4-- ---- Capacify -0 _ 1 Disposal Field: Distance from nearest well- Q_` Distance frorn5�'rl`dation---fQ-_-_------_.Distance to nearest lot line '_��_`__"_�_ Number of lines-------`.--- ----------------- ---Length of each line-----7�-r------------ Width of trench._--r - -' ----_---___-_---__- Type of filter materiaTt.�p�LC_----- Depth of filter material___/Y(_"_---.-.-__Total length---./_ `- _ ----------------------- Seepage Pit: Distance to nearest well---/.OA-..40 ____Distance from foundation--- ---------- to nearest lot �� V p ------------Lining material---�t9C-_k -.Size: Diameter-----3- - .Depth__�< _-------------------- Cesspool: Number of its-__,- - - -- - ----------- ---- ' Cesspool: Distance from nearest well-----------------Distance from foundation.-..--___----_.----.Lining material---_---_"-----___.-.--__"-- \. ❑ Size: Diameter----- --------------------------------Depth----------------- --------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------- ----------------------------------Distance from nearest buiidin ❑ Distance to nearest lot line__"-_____".-.___---_ Remodeling and/or repairing (describe):----------------.---- . ----------•-•-----••-------•----------•-------------------------------------------- ------------------------- --------------------------------- ------------------------ ----------- ------------ -----------------------------------------------------------•- -------------------------------------------- -------------------------------------------------------------- I hereby certify that I ave prepared this application and that the work will 6e-done in accordance with San Joaquin County ordinances, State laws, a rules and regu i sof the San Joaquin Local Health Districts (Signed)-------------------- �_ ---- -------------------------------- --------(Owner and/or Contractor) By:--------------------------- - -- -- Title (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). h FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �/L'----------- 1�c`�"------ ----------- DATE-------- 1---jjf�--- --------- - - ------------------------- EVIEWED 13Y-------------- - ----------- - ------ --- -�------------- - ------------- -- ------- ------------- ------------ - DATE----------------------------- - -- , 8U1cDING PERMIT ISSUED_______ --------------------- ---------------------- _ = Q 'Alteratians an recommendations:_ : _ c -_ L_.� C ._ � �-�- ��: r`" "" r --------- __' = --------------------------------- CY------------------------`-- ^-�'2�„' ------------------ ��^- = -�- -' '~-------L-- ---------- 4 '-� - - ------- ---- r ---------,-LC.- ----------------------- ------- - --------------- ------------------------------------------------- - FINAL INSPECTION BY:...._..... . rA el �------ Date--- --------- --------- ---- - QUIN LOCAL HEALTH DISTRICT 1601 E.Hasalton Avf, StreetT g 124 Sycamore Street 205 West 9th Street Stockton,California z Lodi,California Manteca, California Tracy,California F.P.CO.