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/ FUR OFFICE USE: GS -------- ---- d / --------------------- -------------------- ---- -------- APPLICATION FOR SANITATION PERMIT Permit No. .J%.�1.._ . ---------------------------------------------- --------- (Complete in Duplicate) G/ 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 application is made in compliance with County Ordinance. 549. JOB ADDRESS AND LOCATION------/ la.__ - -----/_____ _� ---- /�.� ----------------------------- -------------------------------------------------- Owner's Name--------------Z- ---------- 1 -4'r-------� --®/rfTi�Nf'L4-1------------ ------------- Phone-Je.6 (0---� ---- Addressff __. 1;/ % :--------•---•-----•---------------------------------------------------------------------------------------------- Contractor's Name................ . �y ` .1 - --;----.-L' -/1'/�p� ------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.I.. Number of bedrooms __Number of baths ..l-__ Lot size ------ ^S-. _......9+!0------------------------ Water Supply: Public system 2/' Community system ❑ Private ❑ Depth to Water Table -40. 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 [f--New Construction: Yes ❑ No [' FHA/VA: Yes ❑ No [3— 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_.............-......._______-------.-...._.---- ❑ No. of compartments------- -- - - ------ --Size--------------------------------Liquid depth------------------------. Capacity--•-------------------- Disposal Field: Distance from nearest well__._r- _._Distance from foundation.e�..'-.......Distance to nearest lot line...02 Number of lines--- /-------------- --------------Length of each hne._�s`�. ....---------------Width of trench__�£4- ..........._....__ Type of filter material--- ©4f_-Depth of filter material__, ee------------Total length...__��-------------------------- - Seepag Pit: Distance to nearest well------_-----------Distance fr m foundation__.. .C�....._...Distance to nearest lot line...Jd..�... 1 Number of pits-------/_1- g S�'� ----- _. 'q---r--------Depth-- �_LSS ----- 0 .........Limn matenal..... ...-.1�� Size: Diameter_-_ ..______ Cesspool: Distance from nearest well-----------_-----Distance from foundation--------------------Lining material---------_-.--_---------.-....__----- X11 ❑ Size: Diameter- ------------------------- ---------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. (— Privy: Distance from nearest weft-------------------------------------------------Distance from nearest building_----_------------------------------.____. ro ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------- ---------------------------- v._6 Remodeling and/ repair g (describe): - _��__ frT...�4 --_ie_- . / ---- -- T� !'"'�` rr�' r� r. � - �1 +' e -� ----e-�-- L ' Wit`-----�"`------ ---- �..._ ------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - -- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State c-lamm,-Ind rules and regulations of the San Joaquin Local Health District. (Signed) F12✓-----. ---------------------------------------------- ------- -- Ow and/or Contractor) By:------------------- --------------•--Zof -------------------------------- - (Title)------------------------------` (Plot plan, showing size of lot, locasystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y __ DATEh',� . .. - REVIEWED BY---------------------- ------- ----------- -------- --- ------------------------------------------ DATE------------------------------------------------------------ ---- ------------------------- BUILDING PERMIT ISSUED------------------------- - ---- -------------------- -------------------------- DATE------ ------------------------------- Alterations and/or recommendations:____.__._G__/f-Gam:-...- :_.. �1_..�..c. ----- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ---------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------- - ----------------- ....-- . --------------------------- - --- - --------- --------------------------------------------------------------------------------------------------------- - ----------------- . - FINAL INSPECTION BY-------- - ----- ---------- Date-----...--- � -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California