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FOROFFICE USE: r i ------------------------------------ --- ------------- r ------ ------------ � ........._ APPLICATION FOR SANITATION PERMIT' Permit No. _ J � Date Issued �vf_...__�� ----------- ----- ----------------------------- --- --- (Complete in Duplicate) ------------ ---------------- E This Permit Ex ires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein if ?-I �� descried, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ' t �'--� + l i C.�FfS? --_f`[L4cc Owner's Name_ -- - :1W_1'� !f ��- -------------------------- t --- Phone-- k Address_____ _....�_! ---------------------- ,. , �f� �� ' --------------- `l' -,� - �1'---- ----- Contractor's Name-------- •--- - --- ----- Phone.. ----------------- I Installation will serve: Residence artment House Commercial Court ❑ Motel ❑ Other ❑ I �y I�Ap ❑ ❑ Trailer Number of living units: -A- Number of bedrooms _ _ Number of baths _ram._ Lot size ___ __ Water Supply: stem pp y: Publicsystem system ❑ Private ❑ Depth to Water Table 'ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 y Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M_'Inardpan ❑ i Previous Application Made: Ilf yes,date____________________) No ®0,New Construction: Yes ❑ No [ FHA/VA; Yes ❑ No R4,— TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarik: Distance from n Barest well_________________Distance from foundation____.______-___-_-_.N a ara No. of compartments---------- ---- ----------Size---- ------------------•-------Liquid depth----------------_-_-_-.-_- Ca._d .Pa._c_i.t.. y--- -_ ------------------- KL��/v 10 Disposal-Fiefd: Distance from nearest well------'-�_Distance from foundation_-X(0- --------Distance to nearest lot line_0____.__... j Number of iines'___/_._.__._______ __ Length of each line__ i , g ` Width of trench._ -------------- -------- Type of filter material_ _/�0 %-Depth of filter material__ _ .__� Total length--� ------------------------------- f 0, 0, See a e Pit: Distance to nearest well________'-^---___ -_ Distance from fou dation___ u3` p g a��_______.D�stance to nearest lot line----------------- �y Number of pits---- ------------:Lining material -Size: Diameter__ ......Depth_ V`/ ,- .~-E� i Cesspool: Distance from nearest well---------- --_Distance from foundation------------------- material _ _ ------------------` Capacity _ _____-___-__ _ El Size: Diameter---`----------------- ----- ---------De th--------------------- - ----- - - - - - -----Li Liquid Ca acitY----- --- �--------------ga . 0\ . Privy: Distance from nearest well-_______________________________________--_____Distance from nearest building..__._____________-_.________.-__-___--- ' ❑ t i Distance to nearest lot line.,. '- - --------------------- ------------------- -------------------------------------------------------------------------------------------------- If a Remod ging.and/orFrepairing [describe]:--- ---- �_' /__ --------/�' �-�--�-- -��---------•---------••----------•--- ---------------------- -- �. -------------------------------- -------------------------------------------------------- t ----------------------------------------------------- -------------'-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. ------- (Signed) /—I-------®--'.�-----�----��/ (�r..Contractor) By:_--------------------------------------------------------------------- ----- (Title) --------- ---- (Plot plan, showing size of lot, location of system ' at;n to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE ------ . ---1� REVIEWED BY '-------- ----- T _ ------------------- DATE- BUILDING PERMIT ISSUED------------------ =- -------------------------- ------------------ Alterations - k -------------- DATE---.----------------------------------------- -- ---- � ------------------ Alterations and/or recommendations:- -------�5 6s? a - ------------------- --------------------------------•--------------------- -------- ----------------•--------------------------------------------------------------------------------------------•------------------------- -------------------------- ------------•---•---- -----------------------------------------------------------;17�------------------ ---------------------------------------------------------------------- ------------------ -----------------------------------------------1-1------------------------------------------- --------------------------- --- --------------------- ------- : FINAL INSPECTION BY. " ------------ Date /f � ' SAN JOAQUIN LOCAL HEALTH DISTRICt/� f 7-11�/ 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California f f Lodi,California ' Manteca,California Tracy,California d h