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FOR OFFICE USE: :. T - � � j--.- _.----._. APPLICATION 'FOR SANITATION PERMIT Permlt No. __ _ - (Complete in Duplicate) —I/ / -------- - ------ -- ----- This P4frmit Expires 1 Year From Date Issued Date Issued -� z 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 ;ounty Ordinance No. 549. JOB ADDRESS ANDS CATION �. 01T1 Z_Y__,f,?-------------------------------------------------------------------- Owner's Name------- ---/---�/-A- Z� ��- --- -�� P------------------------------------------ Phone_Y'4,5-1------ Address h 1 Y•t----- �c xv----C rl2-4Ae------------------ .�Contractor's Name - -- _ S.!` - /1 ---- •-------- ---•- ----- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms Number of baths -------- Lot size _/ '+ Fr ------___----_____________ I f Water Supply: Public system Community system ❑ Private ❑ DeVIh to Water Table -_. ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q"`"�ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No [��New Construction: Yes ❑ No []" FHA/VA: Yes ❑ No Ej� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Pistance from foundation--------------------Material-------------------------------------_.._______- ❑ No. of compartments--------•----------------Size---------------=----------------Liquid depth----------------- --------Capacity----------------------- 11 Disposal Field: Distance from nearest well ----------Distance from foundation?F;O��_/-_-.-.Distance to nearest lot line14Q [ ' Number of lines_---____--/ ., -----------------------Length of each line____ _r� __ 1, id#(i'd�`trench._.__.-?_'.________.__ Type of filter material-___^"- --------------Depth of filter material____--~__-_-_.--_-_Total length___ Q____-___771 P_. /N2- Seepage Pit: Distance to nearest well--------rte -------Distance fropn foundation___6'?.......Distance to nearest lot line___ . wow' // ❑� Num6er of pits.....j /.... Lining material-___- - A.G .Size: Diameter__��'__-___--.. Depth----- - -____________________ Cesspool: Distance from nearest well------------_----Distance from foundation_____.-.__.-.---_Lining ma-serial__...___--__-----.-_-------_________ 4 Size: Diameter----y_----------------�' - -------.-_---- --------------Li Liquid Capacity-'.❑ ry---------Depth----------------------- - q p Y-- ------------ ------.gals. Privy: Distance from ne;restfwwell_____--:!_.-____-__--_____--__________________Distance from nearest building-_-------.___._____.________ ' ❑ Distance to nearest lot Ime--------- - 1 n - � V Remodeling and/or repairing (describe):----- ---�, - �/--"-71.7;�?--------, f f_/_/1/- ------ /4 l/f/-------------------• �• r -----•-----•---••---------------------•------------------------------------- -------------------------------------------------- --------- ---------------•-------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- t 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. (Signed)-------------------- rr- I wn and/or Contractor), 3 ` By:------------------ -- -- - ----- ---- --�--- -------------------------------------------------(Title)--------- - - -- - - - -------- - --------- ----------- (Plot plan, showing size of lot; Iota+io of.system in relation to wells,-buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - ------ - - --------------------- ---------------------------------------- DATE*- VZ,.1A.i-- -------- ----------------- REVIEWEDBY_..._�------------------- ------ -------------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------- i BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------w --------------------------------------------- Al+erat'm and/or recommendations: ----- --------------4---------------- ----•-------- - ---------------------------------------------------------------- ------------------ --- ----------------------------- __�_.f t ----- ---------------------------------------------------------------- f _____________________ s r ------------ --------------------- ------- - ---- --- - - ----------------------------------------------------------------------------------------------------------------------------- -------------------------------- FINAL INSPECTION BY:--------- - Date. ---- ------- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c o.