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R OFFICE USE: ----------- -------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ .-19... ----------------- ------------------------- ---- -------- (Complete in Duplicate) .."t Date Issued _ _ ------------------------_-_-_-- --. This Permit Expires 1 Year From Date Issued 4 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. JOBADDRESS AND LOCATION----------`? 3 --------�.�' � f------------------------------------------------------------------------------------- Owner's Name------------fie------ yZ..r.Ae1- ---------------- ------------------------------- - -------------------------------------- Phone-.-.-------------------------------- Address------------ -------r1----------•-------------%a-%-----------------------------------------------.-----------------------------•------------......--------------------------...---- Contractor's Name------ . _�f rff___---s ,T_, Phone__YE?_Y_7Z_7__6--- Installation will serve: IResiidence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0� Number of living units: __/___ __ Number of bedrooms L__._ Number of baths __l__-- Lot size ___1_- --- -!-G---------------------------- i Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. I Character of soil to a depth of 3 feet: +Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0'' Hardpan ❑ Previous Application Made: {If yes,date--------- No [�3— New Construction: Yes E] No [J-- FHA/VA: Yes ❑ No E— TYPE t TYPE OF INSTALLATION AND SPECIFICATIONS: r, t (No septic tank;or cesspool permitted if public sewer is available within 200 feet.) I v # Septic Tank: Distance from nearest well -______Distance from foundation__-__ __`__.__ _Material-___ e c�1— ---g--------_-_--__-___ ❑r No. of compartments.......Z.._.______--__.5ize___�_'K�'�x-F_l---Liquid depth__.__:4/__r__-___-_____Capacity...'?A0 �� Disposal Field: Distance from nearest well....MU-------Distance from foundation____«__ .......Distance to nearest lot line-5------------- .. 21� Number of lines----------/-------------------- --Length of each line___:2._�!`T4__LS!----Width of trench_____Z._ -------------------- Type of filter material.__-._ o_sK--___Depth of filter material__--�_Y-".-______.Total length____xv__' .__ --________ Jr r ` , Seepage Pit: Distance to nearest wefl___ffSa- ---___Distance from foundation----!__fl..........Distance to nearest lot line_47�._____._- [LY Number of pits. - _- --__-._______Lining material____� Diameter_-_ zfDepth__ _________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------_----------- Lining material.......___._--________-__________-_.El ' Size: Diameter- -----------------------------------Depth------------------------------------------- ---=----Liquid Capacity---------•--------------- -gals. Privy: Distance from nearest well--------------------_----------------------------Distance fram nearest building_- ---------------------------_._. ❑ Distance to nearest lot line---------------------- ------------------------------------------------ ---------------------_------------------ ------------------------- 1 ` i S Remodeling and/or repairing (describe):- ------ -_a---------t!!-V_xt.---------3--------------------------_---------------------------------------• r a 1 - -----� C. ,u-• ,-'----------- ,,.. -------=- ----- �� C -- ---- -- �i-r.....�--.------- --'��'------ - - -------- ------ -- �l'L- c Q•P -'�rte` = r----- ------------------------------------- --------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. '� ._ fel --_ -------------------------------------- -----(Owner and/or Contractor) (Signed)------------ 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_ __- y/ 6`} DATE -- r- , REVIEWEDBY-------------------------- ---------------------- ------------------------------------------------------------------. DATE------------•----------------------------------------------- BUILDINGPERMIT ISSUED------------- ------------------------------------------------------------------------- ------------ ATE-- --------------------------------------- ------------------ Alterations and/or recommendations:____ ` ---- ---- -- -----------------------------•----------- ----•-------------- ------------------- ... --------- ---------- ----- -------------------------------------------------------------------------------•------------------------- ----------------- -----•------------------------------- I ----- ------ ------------------•------------- -------------------------------------------------------------------- -- -------------- - 2 zr FINAL INSPECTION BY:..--- `.G<r --------- ----------- Date------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California - Manteca,California Tracy,California F.P-C q.