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FDR OFFICE USE: -----.-- .- w .. _�. APPLICATION FOR SANITATION PERMITPermlt No. S I --------------- (Complete`in Duplicate) - __.___ This Permit Expires 1 Year From Date Issued 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 LOCATION_..... -- ( t �_iwr ' lc - L -------------------------------------------- Owner's Name- =---------- l�?4t__ 'p_ f---------------------------------_ - ---- ---------- Phone---------------- ------------ - I Address �_. /�5------ Contractor's Name --_. /. ------e---- "--- ------------------ - --•--- Phone Installation will serve: Residence 0--Apartment House ❑ Commercial ❑ Trailer Court -❑ Motel ❑ Other Number of living units: ___!___ Number of bedrooms _.2:.__ Number.of.baths ___ Lot size _ ---------------------- Water Supply: Public system [Community system,"El Private ❑ Depth''to Water Table-------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A - ardpan ❑ Previous Application Made: (If yes date____ ) "Nb '�lew Construction: Yes ❑ No FHA/VA: Yes ❑ No❑ -� TYPE OF INSTALLATION 'AND,SPECIFICATIONS:, " T (No.sepfic tank or cesspool permitted if public sewer is available within,200 feet.) A Septic T nk: Distance from,- well __-__-_ __`____Distance from foundation ______________ 4 - _ .Material ------------ ----- - ---------- No..of compartments_-_-_ __. _____._____Size-------------------------------- Liquid depth--------------------------Capacity_____ .---------------- rice _ 3 isposalr Distance from nearest well ____._Disfan.ce from foundation__A�pZ-____.Distance to'nearest lof line__, -------- /.-/Number of lines- --— _-� Length•of.reach line__-_____&O% Width of trench �exl .-_ � ; 'Type of filter materia+ c __Depth of filter material __ Tofial length____.___ 09 �Q_l______________ r Seepage Pit: Distance to nearest well __ _'____Distance fr`oo6 foundation----6� Distance �Ip nearest lot line � V11� 'f Number of pits._------ -,--.--Lining material i oCjSize: Diameter.- > _ Depth --- Cesspool: Distance from nearest well-----------------Distance from_='foundation--------------------Lining material_ - - _____ i ❑ Size: Diameter----- --------------------------------Depth-------------------- ---------Liquid'-Capacity ------- gals. Privy: Distance from nearest well-.-------- __---------------------Distancefrom nearest building _ ❑ Distance to nearest lot line ___ _ __ ____ -- - --- - Remodeling and/or repairing (describe): f . -------------------------------------- - -------------------------------------------------------- !- -------- --- -------------------- ------ ---- ------------ ---- I hereby certify that I leavee�epared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and and r gulations of the San Joaquin.Local Health District. _11 (Signed) ---- ----��-------------- --- -------- - - -- ------------------------------------(Owner and/or Contractor) By:--------- ------------------------------------------------------------------ -------- -------------------------------- ---- (Title) - -- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR;DEPARTMENT USE ONLY APPLICATION ACCEPTED,BY_-_-_ _ _ -, -_`e:::::2P1 - ----• ----------------- -- DATE------- , '3 ---- -- --- -- REVIEWED BY------------------ -------------------- ------ DATE---- --------------- -- --- -- -------- -- ----------- ------ - BUILDING PERMIT ISSUED_______ _______ _ __ ----------------- DATE__ -- Alterations and/or recommendations. / ,/-,� s �Y -------------------------------------------- __ __1____ ----- ------- --- ---- -------------------------------- ----- ----------- --- ------ - ------- ---- --------•---------------------------------- -- ------- --------------•- ------------------1, -------------------•-------------------------------- -------------------------------------- -------------- ------ ------------------- -------- --------- ------- --------------&------------ FINAL INSPECTION BY:..--__ -_: , Date ----------- -` 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.CO. -