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7 u,,---- --------- i-J.--. :- _ ._ f.__.____. APPLICATION FOR SANITATION PERMIT Permit No'i.__ _ r (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. l JOB ADDRESS AND LOC ATI N___-__ __ ---- 4? _ /4N f I Owner's Name _. 7.f _--- -- -------------- --------------- ----- -------- Phone_ . _l --------------------------------------------------------------- Address 5 . :------ Contractor's - Name-----�.--� -- ------------------------------------------------------- - - ------ Phone----------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j___ Number of bedrooms •_4 Number of baths __`.._ Lot size --Av-X---7 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _!_____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan [] 1 Previous Application Made: (If yes,date--- ---_---------..1 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.) Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material__.___-_-._.___._._ ❑ No. of compartments-_------ ---------------Size_-------------------------------Liquid depth------------- ------------Capacity-------------`:----- Disposal eld: Distance from nearest wefl. - Distance from foundation_.t2.s,: Distance to nearest lot line_________.__ ~; Number of lines_:_____-------- --------------Length of each line____-��_�_ __._._.Width of �y —r Type of filter material___�__ t�fF ---Depth of filter material__Ap--_- P -- - -Total length----». tl'---------------------------- Seepage it: Distance.to nearest well____--_____________Distance fr9rm, foundation----- to nearest lot lin e_,/,C3._--____ pC� Number of rpits-.I/--------------Lining material Size: Diameterff -- _-3-�-- �---- Depth- ,v.�-„�--------- �----- f Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Linin'l g materia!___-...___-._-._____ El Size: Diameter---- ---------------------------------Depth------------- ---------------------- -------------Liquid Capacity - ---------------------- gals. # Privy: Distance from nearest well________________________ ___..____Distance from nearest hAdin ❑ Distance to nearest lot line---------------------------------- --- ------- O Remodeling and/or repairing (describe):_...____ -__ -” ` i --------------------------- - ----------------------------------------------------------------------------------- ------------------ f ---- -------------------I------------------ I 1.y.' Y ---------------------------------------------------------------__ -_ _-__-------------------------------------------------------------------------------------------------------------------------------_ ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-Coun+y ordinances, State law and regulations of the San Joaquin Local Health District. ' oe (Signed) ------ -- - - ---_.._______ ner nd/or Contractor) SY: -- ---------- ..-� ..,._. ------ ------------------------------------------ -----------------------• - - ------- (Title) (Plot plan. showing size of lot, location sys+em in relation to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- ---� ---'----�-- ------- --------------------------- -- ------------------ ----- DATE.--- ��--'�/--�-�--�------------- -- ---------- REVIEWEDBY------------------------ ------------------- - -- ---------------- ----------------- --- DATE ------------------------------------ - BUILDING PERMIT ISSUE6-------------------------------------------------------------- ------------------------• DATE---------------------------- - - Alt ration/s and/or recommendations:_-_-__.- :. f 11-... �r � r�J----------- a te- /� Z . , Lf, 7 E'`� -*.�' =.-- .-- ,---------------- ------f------ -- ------------------ ------------------------------------- ------------- ---- -------------------------------------------------- ----------------------- FINAL INSPECTION BY:------- SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.Hazelton Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California