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FOR OFFICE USE: - -- --------------------- 7 - ------- - ---- - -- .. ------------------ �0 APPLICATION FOR SANITATION PERMIT Permit No. _. .._ -_..... . --------------------------------- -------- ---- ---- --- (Complete in Duplicate) Z 5.� 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 ade in complia ce with County Ordinance No. 549. q�t� S. PX-t PX --Aj{ JOB ADDRESS A P LOCATION.. __Q+l1. t. .�r �,. •__p' k�f �_ t 4.i2e--- _ -h.• -ham' Owner's Name------ --OA---lluc--------- � ��-5_ ---------- ---------------- Phone---------------------- - Address------------------------- ----------Y------ �-1(------------- ..... --------------------------- Contractor'sName----- D-�----�,U-�-��----•-•---------------------------------------------------------------------- ---- -------- --- -- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: _____'_ Number of bedrooms ____ Number of aths - Lot size _ ------------------- ------ Water Supply: Public system E] Community syste Private Depth to Water Table -14- ft. Character of soil to a depth of 3 feet: Sand Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- -----___) No ❑ New Construction: Yes J? leo ❑ FHA/VA: Yes ❑ NoZ�.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_ --_:_____Distance from foundation---A�__.____.__.Materi�l__ _ _ '1 C_ _ __________________ No. of compartments.---------- .,.........Size_-- - -x --P.._--____Liquid depth----�1 .._----------Capacity---- k -v-------- Disposal Field: Distance from nearest wail_-=�------------Distance from foundation__,�_%9__l--------Distance to nearest lot line_-_--____- Number ofrlines______->-_---�___---_---Length of each line___ �� .a_----_ Width offrench._�1)-//-.________________ Type of filter material---- w---___________Depth of filter material______ _ _._-------Total length-----J-2--sn---________________________ Seepag i : Distance to nearest wefl__w -L"' _-__-_Distance Prym foundation-_.JG?_r______ stance to nearest t �s----------- Number of pits-.- _�_______-----_ __Lining material_ _____Size: Diameter___=�51 -----Dept h--- ---__---_____ S Cesspool: Distance from nearest well------_----______Distance from foundation--------------------Lining material------.------------------------------ N Size: Diameter ----------Li Liquid Capacity i ❑ - Depth q p Y gals. Privy: Distance from nearest well_______________________________________ -Distance from nearest building____------_--------------------------- -. ❑ Distance to nearest lot line-------------- ----- ----------------------------------------------------------------------------------------- -------------------------- aw---------- Remodeling and/or repairing (describe}---------------------- ---.- . _------_ �---------------------- 6 ----------------------------------------------------------------------------------------------------------- ------------------------------------------------ -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, anfj�ocafion nd regulations of the San Joaquin Local Health District. (Signed)---- Q --- ------------- --- ----------------------------------------------------(Owner and/or Contractor) - --------------------------------- BY=--------•---------- ----- -------------------------------------------(Title)---- E��1--------------------------------- (Plot ---- ----- -- ---- --------- (Plot plan, showing size of o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ______________________ DATE__---61!6 REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- , DATE---------------------------------------------- --------- Alterations and/or recommendations:____�. j �_...........:,___ __ __ ____________________________ _ - ./�_.-�/� 7 �5"-a tr 4� ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY:. ------ ...1- "'4" ---------------------y---- Date.---- '_ _ .'....rP-.`"._.---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.