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FOR OF iCE USE: g -- J- ------------- ---- I- f y6��`�----------- APPLICATION FOR SANITATION PERMIT Permit No. 1 .'-�.. ----- '--------- -------------------------------------- (Complete in Duplicate) -- This Permit Expires 1 Year From Date Issued Dade Issut:wd 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 Ordinance No. 549. JOB ADDRESS AND LOCATION__._FVC---...47 /`----------------------------------------------------------------------------------------------------------- �r ----�Q -e-1rp--------------------------- Owner's Name----- --- - --------------------------------------- Phone..-------•-•-------------------•-- Address------------V4?/.17�----------------------------------------- Contractor's Name---------------Ar-_.: sflf------------------------------------- -------------------------------------------- Phone------------------......----------- t. Installation will serve: Residence I3'Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: Z--- Number of bedrooms >3--- Number of baths A_ Lot size/, -0 -- ---✓-f�__------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,go;f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U-1-lardpan ❑ Previous Application Made: (If yes,date......... ..........) No g?" New Construction: Yes ❑ No [�q ~ FHA/VA: Yes P— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanks Distance from nearest well-----------------Distance from foundation--------------------Material----------------------__------------------------. i /'/'s 64 No. of compartments--------------------------Size--------------------------------Liquid depth------------ - -----------Capacity-•-------------------- Disposal Field: Distance from nearest well_ I ii.._Distance from foundation---__-t�-..._ _Distance to nearest lot line__!S....... f y j� Number of lines--_----1----------,-�--------J Length of each line--------VU`--------------Width of trench------- _`r---------------- ` Type of filter material> _l __.__Depth of filter materia!____/_9�_`_`________-Total length___-___- See a Pit- Distance to nearest well------ ` &istance f m fdation__ --_a----- Distance to nearest lot l -------- Q Number of itsf-------------Linin material -Size: Diameter- �..�.............De th Cesspool: Distance from nearest we!€-----------------Distance from foundation------------------- Lining material-:._.._-__-_----.--.----.------------. ❑ Size: Diameter- -- _----------- -------- -------Depth--------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--.._._-._--__._-------__.____._--.._. ❑ Distance to nearest lot line-- --- -------------------------------------- ------------------------- ---------------------------------------------------------------------- } f �f Remodeling and/or repairing (describe:-- ----- --�..Z_�/�. �C/��t��_�f____J_ -'----------------- - ---•------ --------- --- • ---- • ---------- --�--- �� 4{ --------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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) p � --------- (@major Contractor ----- ---- - By:------------------------------------------------- ---------------------- --��1�---- --------------------(Title ---� �w--- ............. (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). p� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !:-�'ulCl.--------.------------------------------------------------- DATE--------------�r/��-------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------ - ----------------------- BUILDING PERMIT ISSUED------------------------------------------------ ATE----------- ------------------------------------------------ Alterations and/or recommendations:---------- - Lp '` -- - 1 --I------- - ----- -=--------------------------------------------------------- ------------------------- --------------------------•------•-•---------- ----------------- t --- - - - - - - - - ------------------------------------------ ----------------------3.-1.~4 z__ -� ---------- ------------------------------------------------------- --------------- ------------------------------------------------------- ---------- ---------- -------------------------------------------------------------------------------------I--- ----------------------------- ----------------- ...... ------ ------ -- -- ------ - -------------------------------------------------------- ---------- ------- -- ------------------------- -------- - ------- -------------------------------- FINAL ------- -------------------- FINAL INSPECTION Date.- ---- -1' s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocktonr California Lodi,California Manteca,California Tracy,California F.up.❑p.