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OR OFFICE USE: � �s+---------------------- --------------------__-___--__-____--_ ,f.,c-_. APPLICATION FOR SANITATION PERMIT Permit No. ..,1 ��_.... -- ----------------------- (Complete in Duplicate) 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 No. 549. JOB ADDRESS AND LOC ON-- ePI1i---- lYep� Owner's Name- ---- ------- �- �-�-•----••,-•�--�---�f'� -�--��-------------------•--=--_--••--•-=----------•- - Phone--'�7 7-------------••---- ; Address---- 4- -_I-S-----.<Y�--------= -----------------------------------------------------------------------------------_------- r-i -----..d/�� -�,��y------/ i►�-C'------------- ------------------------ �a7---- Contractor's Name______ Phone__ _g' ____ Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court [-] Motel E] Other El/- Number of living units: __ --- N ber of bedrooms _-- Number of baths _1---- Lot size __-_.4{!!/- ____________________________ Water Supply: Public system Community system 0 Private ❑ Depth to Water Table 1;.& t- 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 2' New Construction: Yes ❑ No ©-- FHA/VA: Yes ❑ No E�-- TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest welt_________________Distance from foundation--------------------Material-----------------------------------.______-__-__. ❑ No. of compartments--------------------------Size----------------- ------Liquid depth_-------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- 04 ❑ Number of fines-----------------------------------Length of each line-----------------------------.Width of trench------------------------------------ Type --- -----------------Type of filter material-------------------______Depth of filter material------.---------.------Total length------------------------------------------ w it: Distance to nearest w II____—_______-__Distance f�_404"lle-Size: foundation__?) _________.Distance to nearest lot line__,,��'`�______ N .__Linin materiai_,J Diameter-__._Number of pits 9Depth oa,.x�"/ }. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__._.----------------------__-_.____. J' ❑ Size: Diameter----------------------------------y--Depth--------- - ----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weft-..------ : -------- -----------------------------Distance from nearest building------------------------------ Distance to nearest lot line-------- ----------------------------- - ------------------------------------------------------------ Remodeling and/or repairing (describe: l -r�------•---------------- �/S�/��------------------------- ----------------- ----- -------------------------------------------- --- - --------- --------------/G--- 'a *err .� BLC- ----------------------- --_- --- '2e-'+�/-E ----------- - -----------------J-- --------------------------------------------------- ---------- I hereby certify that I have" repay d this application and that the work will be done in accordance with San Joaquin County ordinances, Staf�lavv5, an ru es a regulations of the San Joaquin Local Health District. r (Signed) { f f+f e--------------------------------------------------------- ne and/or Contractor) By:--- - -------- - e—fr -------------- ---------------------------------(Title)----- ----- --- - - - - (Plot plan, showing size of lot, location of ysfem in relation f wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -------- - ---- - -- ------------------------------------------------------- DATE----"- -j --Z' -------------------------- REVIEWEDBY-------------------------- --------- -- ----- -------- --- ------- ---------- ------- -------------------------------------- DATE------------=---------------------------------------------- BUILDINGPERMIT ISSUED-------------- -------------------------- ---------------------------------------------------------- DATE-------------------------------------------- ------------- Alterationsand/or recommen.ations:------ ------------------------------------------------------------------------------------- ---------------------------------------------------------------- ( -----i0o -V,4 rirs� -_ ------------------------------------- ---------------- ------ ---------- ----- --------------- ------------------------- ------- ---------------- ----------------------------------------------------------------------------------------------------- CP - FINAL INSPECTION BY-------------C --------------------------- Date------ Y' ---------- ------------------------ --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.14axeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.