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FOR OFFICE USE: �`� APPLICATION FOR SANITATION PERMIT Permit No. ...... ... ... ... 3 C� [Complete in Duplicate] .............. This Permit Expires 1 Year From Date Issued Date Issued ___/�J_.-__.___: 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. 1 zll_/� t �2,0 E lE- P?-A,4ks F,,O- JOB ADDRESS AND LOCATIO _________ _______�-_c____�_�_�.._�____,.__�_`�_��_ -"L __-____ ----PA441W--------- -- ----------------_------------ 1��j-1� ,�} Y r - Owner's Name_ 1J {-L�-'------ -------------------------------------- ----------------- Phone--- �_�r •--- Address---------- -- - -------------a--------------------' ---•-------•-•---------•----•-------------._....---- ------------------------------ - ` 4/6�;j/C12 Contractor's Name Phone.--•----•--•--.-- •-------- Installation will serve: Residence RQ.—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- Number of bedrooms _3._ Number of baths __ -_ Lot size -----.-_�r�'�r�_L._�_ J---------------------- Water Supply: Public system E] Community system [IPrivate Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla$ Loam [I Clay ElAdobeX Hardpan C1 Previous Application Made: (If yes,date--------___--._____I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e. pt' Tank: Distance from nearest wall-----------------Distance from foundation-------------------Material---------------.--------------------------------- No. of compartments--------------------------Size------------------------- --:--Liquid dept;-------------------------Capacity------------- Disposal field: Distance from nearest well/046.--± Distance from foundatrion---6_D-------Distance to nearest lot I fe_S� E;f� Number of lines--------_----- f� Length of each line--!_,7�---------- -------Width of french---ls-_- _------------------ �- Type of filter material-S,J 4' [.r_Depth of filter material___,,/f-_'___-.Total length--------------------- Q_-____---_- rn Seepage Pit: Distance to nearest eiI`_. �_...-__Distant. m fo ndation___ Q._.___.Distance to nearest lot line___ _ _ Number of its____-. ..`_".___.-______Linin material - i Size: Diameter__.. p / g --- �-�-----------Depth_.-�-�'--------------------- Cesspool: Distance from nearest well-__---_-.-_..__Distance from foundation--------------------Lining material------------------------------------- 0 _____-------..____--_-.- _------_.❑ Size: Diameter--------------------------------------Dept h------------------------------------ ---------------Liquid Capacity---_----------------------gals. Privy: Distance from nearest well-------------------------------------_-------_-Distance from nearest building-------------------------------------------- F1 -------------------.--.--.-_-.._.❑ Distance to nearest lot line._ -- --------- ---------- --------,---------------------------------------------------------- ---•--•----- - ----------- Remodeling and/or repairing (describe)------------------------------------------ ---------------•-------•--•----------•---------------------------------•--•----------------------------------------------------------------------------------------- ---- ---------------------------------------------- -- ---------------------------•---------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------•---------------- --------------------- ------------------- I hereby certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, Sta laws, nd rules a regulations of the San Joa uin Local Health District. A '. (Signed.)-------------- - ---- --- ------------------ - -- --- - ----- -- - ---- --.-- -------------- (Owner and/or Contractor) By:--------------------------------------------- ------ ----- --------- ------ : -------------(Title) (Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i �tir� APPLICATION ACCEPTED BY--------------- ------------ ` -...r_------------------------ DATE------/�---1 ------------------ ---------------- REVIEWEDBY--------------------------------------------- --------------------- ---- ----------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT 't S ---1-'------ ISSUEtD----- --------'--'-------------------------t----- ---------------- •------ ------ ----------------'--�=-�---DATE---------- Alterations and/ r recommendations: . ------��wv --=�•-•-- < " r - -- — --�--- -------:----------------------------------------------- ----------- `-------------------------------- -- - ---- , --------------- -- -------- ------------ --- �`-"�Z-`r'-==��, ---��—s-t-- '-c-s...-Y�.��-�=---'-`— `J✓�r C FINAL INSPECTION BY:. -- -----------•- ------------- Date----'----._�1��--------------- -----------------------------OAQUIN LOCAL HEALTH DISTRICT f60t E.Ha:elfon Are. Street 124 Sycamore Street 205 West 9th Street r� Stockton,California Lodi,California Manteca,California Tracy,California F.P.r Q.