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FOROFFICE USE: -- - -- --- --------- - ______ APPLICATION FOR SANITATION PERMIT Permit No. ......... - --------------------- --- - ---- ---- [Complete in Duplicate)--- ----------- -`—�---�- ----��C-a ..................................................... ... This Permit Expires 1 Year From Date Issued Date issued f&a- �� -� Application is hereby made to the San Joaquin Local Healfh District for a permit to constr and install the work/herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN ION--�Z-2 T .j--- C----.- --tt--T -- X.....Pee.... Owner's Nae-: t ---------------------- Phone------------------------------------ Address-------------- 6�uY Contractor's Name-- f3 � �L-elS,i'-,r�.- L��xl. 1x�G--------------------- J Installation will serve: Residence 2- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms —5--- Number of baths -f/,-Lot size _- ." --4- ----------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table /Sft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 1 Sandyr Loam X- Clay,Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date____________________) No New FonstructJOY'kes ❑ No ® FHA/VA: Yes ❑ No k 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---..--_--..__-_--..-____.__--_--_-__------------ F ❑ No.®ok compartments----- - ---- -------- ----Size------..----------- ------------Liquid depth--------------- --------Capacity---------- ------- ---- Disposal Field`: Distance Ne - nearest well-_ '-_-Distance from founda#ion.//q._!�-----Distance to nearest lot line-,. .------ Numbe o Ines------ ------------ -_---___-IN -._den to of each line---!__E?d. ._.-..------.Width of trench----- (. _____-___-. Type of filter material--.15 , LX/ ---Depth of filter material----!'_O_`_`.------Total length------,-42t`2------------------- Seepage -`----------------- p g 4 etto nearest-well----------------------Distance from foundation--------------------Distance to nearest lot iine-----.---_--__--- See a ePit: Dis#anc ❑ NumbEV0Lfj.pits:r--�i-------------Lining material-----------............Size; Diameter----------------'----!D_8pth.�-------- ---------------- t. CesspooL°' "�D stt., ii'Jfrom near st well---------'._---:_Distance from foundation--------------------Lining materia ---_----_.__--__-----_--_ - .�e. I - F1 Size: ameter--------- ----------- ------- -------Depth----------- Liquid CapaciY gals. Privy: Distan 'from near st well---------------------__________________ _____---Distance from nearest building_-___-__-_._____________----__.____--_..-. ❑ Distan to nearest o ire------__-.-------------------------- ------ ------------------------ - �r ------------------------------------------------------------------ Remodeling and/or re airing (describe): __-. C' .-�jQ----- � '�--�' /!YC-.--- �� 41--------------------- ' -------- -------------- ------------------------------R------------------------------------------------------------------K_^---------------------------------------------------------------------------- ---------------------------------------- ----- -W--- I -------------------------- ---- - -------------------- ------ ..� ---------- --------------------------------------------------- ----------------4---------------------------------------------------------------------------- I hereby certify that I heyp prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rule`s:and regulations of t San Joaquin Local Health District. (Signed)---------- (Owner nd/or Contractor By:.-.----- -�=_" --- � --------- - --------------- -------------- (Tit4e)----- ----- .-....... - -------------- (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc.,"can be placed on reverse side). FOR DEPARTMENT USE{ONLY APPLICATION ACCEPTED BY--- I -/)- ------------- ------------------------- DATE------ ------------------------------------- REVIEWEDBY-------------------------------------------------- --------------------------------------------------------------------------- DATE------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------ DATE Alterations•and/e"eeemmendaCGn --------- -- --- --------------------------- ------------------------------------------------------------- ------------------------------------------- ------------------------------------------------------------------------------------------------------------------ -------------- --- -- ------- ------ - --- - -------- ----- ------- ------ --------- --------------------------------------------- -------------------------------------------- ------------------ FINAL INSPECTION BY:....�.- ----------- Date------- :- ----�--------- ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetlon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California F.Rr O.