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# =r, .. - r=te --- -------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. - ---- ------------ -------------------------- (Camplefe in Duplicate) This Permit Ex fires 1 Year From Date issued Date issued 1 3a � 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 compliant with County Ordinance No. 549. JOB ADDRESS AND LOCATIO Zr" JQ `r '-' /} 1J_��. }1 t---- - '''°ate D A 11 s� Owner's Name �, 1 ! - ........--- --------------- -------- --- --------- Address--------•--------1---T�--'_.--- --•-- - -- - ------ one---------------------•----------- Contractor's Name--------f�lhl N_�-�''�--_---••-_----- "•- - - - . .. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Phone__"-• , ❑ Mote CHfci;Etv Number o{ living units: __— / ❑ Other ❑ yp��— ' g -- Number of bedrooms ` Number of baths _ Lot size !i L- .1--- Water Supply: Public;s stem / ------•----------- PP y� y ❑ Community system ❑ Private Depth to Water Table 1-s._ ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: (If yes,date___________ "-) No New Construction: Yes ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPiCIFICATIONS: 2� leo ❑ FHA/VA: Yes ❑ No 0— -}�. .. '-;+,( �.. .. .. P _. P,rte _�_'_ _ No se ttc tank#or cess ool ermitfed�if public sewer er i availablewithin 20o 'et.} Septic Tank: I Distance from nearest well__• "-__,Distance from foundation__"_. __.___.__.Material___ � - No. of compartments l = �� Size.3Kg-X-�____------Li Liquid de th_---� I q P � --7----------Capacity----- ---D�_____ Disposal Field: Distance from nearest well...`� °Distance from foundation___1.0 --- __.Distance to nearest lot line_-- `.. ' Number of lines_____"__ .--- ! � Type Length of each line_ --��- r --"_-Width of trench 2j r ------------- --------- I yp of filter material__-_ _SCK--_ Depth of filter material_____l�__. Total length----------s0__'__ _________ Seepage Pit: Distance to nearest well________________ ------ __-_-Distance from foundation___________________Distance to nearest lot line__.-_______""---_ { ❑ Number of pits-------n------------Lining material---------------------.Size: Diameter_---•----------- - " Depth --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.____------_----------___ ❑ Size: Diameter-- Depth t ` --------------------------------Liquid Capacity- ---------------------------ga-ls-. Privy: Distance from nearest well _____"___________-------------------------.----Distance from nearest boding------------------------------ Distance to nearest lot line____".______ Remodeling and/or repairing (describe] --------- � -----_____ f ------------ ------------------------------------ -------------------------------------- ------------------------------------------- - ------•-------- ------------ ----------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. ---- Owner and/or Contractor) ------------------- -BY.'' - ------------ {Ti#1o� _(Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). t 'y: ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ -0 -------------- ----------------------- ------------------- DATE-------I - REVIEWED BY --- -- -- ------ -------------- DATE-------------------------------------------------------PERMIT ISSUED-------------------•----- ---------------------------- -�-� --------------------------------------------------------------------------._ DATE Alterations and/or recommendations:_..f ........... .............. --------- r I ----------------- -------------------------- ......... --•---------------- ----- -------- --------- •- ----------------------------------_ l- --- - - - ---- - --------------------------------------------------------------------- FINAL INSPECTION Date"- -d _ ----------- 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 - Trnty,California F.P.Ca.