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FOR OFFICE USE: 1 rl ----------- ---- /U.0 _ '�` , / Q� �] . .:"----=y-----.-----P_ferL.__ APPLICATION FOR SANITATION PERMIT Permit No. _,!_!J___�1___..__ =----------------------------------------- (Complete in` Date Issued_ Duplicate) 9rJ _.._------------------------- This Permit Expires ] 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 made in compliance with County Ordinance No. 549. wB ADDRESS AN LOCATION l-M JOB JO O ner's Name------ ----- 41irt-0- -------------------------------------------- Ph one 1 P4 Address ----- -------- ....... ---IS7---- ---------------------"---------------------------------------------------------------------------------------------•---------------_ Contractor's Name--------------------_all-, ------------------------------------- -------------------•------------------------------------------- Phone--- --------------------------- Installation ---.----•-------Installation will serve: Residence ❑ Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: _. ____ Number of bedrooms _ _ . Number of baths _. _ _--_.____-_ . Lot size _ X :_a.5 --- Water Supply: Public system 12-11"Community system ❑ Private ❑ Depth to Water Table -------- ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E315-ardpan ❑ Previous Application Made: (If yes,date-_----..s':.......-) No [ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No Ej I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ > Septic nk: Distance from nearest well..�4%L Distance from fo nclafion___40----------Material.. No, of compartments_-____-__ ----------Size_- XS_X__q-_----.-----Liquid depth----- .........Capacity__/Q41V /S Disposal Field: Distance from nearest well --„Distance from foundatio��Df--------.Distance to nearest lot line_-S_._______.. Ey”, Number of lines------------------ ------- Length of each line------------------------------Width of french-------`7�----•----- ---------- •-- --- Type of filter materi4 _�_,Afck---Depth of filter mai-erial____J _ _ Total length_________ _____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_--__---_--__-.$_.Distance to nearest lot line----------------- ---- El Number of its-----------------------Lining material----------------------Size: Diameter.-.---------------------Dept h--------------------- ------ 0 Cesspool:". Distance from nearest well-----------------Distance from foundation_..................Lining material------.------------------------------- 0 ► ❑ Size: Diameter--------------------- - -------------Dept h---------.--------------------- -- ------- Liquid Capacity- -----------------------gals. %n Privy: Distance from -------------------- -----Distance from nearesf building----------._-----._.__------._-------_-. ❑ Distance to nearest lot-lire----- -------------------------------------------------------------- -------------------------------------------------------------------- Remodeling ----- Re " modeling and/or repairing (describe:-----'-- ------------------------- - ---------------------------------------------•------------------------•-----------------------------------------•3, ------------------------ -•----•-----------------•------------•---------- r------------- ----------------------------------------------------------------------------------------•-------------- ------------------ -- ---- ------, - ----------------------------------------------------- ------ ---------•----------------- ----------------•--f------ -`---- - -------------- -------- --------------------------------------------- ---------------------------------------------------- _ ,d f t. I hereby certify that I have prepared this application and that the work will done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local He t District- (Signed)-------------------------------------------------- ----------------------------------- Owner and/or Contractor By------------------------------------------------------------------- ----------------------------------- ----------------------------------------------- (Plot -------------------- ----- - -------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -- t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- � - ---------------------• ------DATE---//_-1-_ ;;7_1j�------------------------- ---------------------------------------- -------------• ----- REVIEWEDBY--------------------------------------------------- ---------------------------- DATE----------------------------------------------------------- BUILDING - -BUILDING PERMIT ISSUED----------------------- ------------------------------------------------------------------------- DATE-- --------------------------------"----------------------- Alteratjons and/or recommendations----------------------------------------------------------- _------------I--------------------------------- --------- - s 3��--- -G�--� - �---- �'_ tG_ dc�C-_�.�� , �.'� ........................ --------- -- ----- ---- --------------------------------------------------------------------------------------------------------------------------- -----•--------------------------��.._�., .-�.-- - , ' ------------------------------------------------------ --------------------- ----- ----- ---- ----------------------------- - ------------------ ------------ ------------------------- FINAL INSPECTION BY-------------4 c< -------- --- -----' -. 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 t: . r•.a.cn. 4