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------------- --------------------------------------- ., -------------------- ------- - y _ _________________________ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------- (Complete in Duplicate) ------- --- -------------- This Permit Expires 1 Year From Date Issued Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This application is made in compliance.with County Ordinance No. 549. (Xi7, . JOB ADDRESS, L Y AND LOCATION__ - ->< F ` 1 } � - • �- --�4---14_s�----- --�-----�--tom.-�-�----- �-�-�------ Owner's Name_: �� --------- ------ . ( --------- Phone ': ? Address t =� : -------------------- ----A ------------------- Contractor'st Name--__ ____ ------•--- Phone Installation will serve: Residence AIL Ipartment House ❑ Commercial_ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms _-J_ Number of baths �.� Lot size -_-_.-_. .. 1D 0- 6�-��--5----------------- Water Supply: Public system ❑ Community system E❑ Private K Depth to Water Table 4-6.- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ElSandy Loam E] Clay Loam K Clay E] Adobe ElHardpan [❑ Previous Application Made: (If yes,date__.-..____ --------J_No,X. New,Construction: Yes Dq No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , . ,..;, �(No septic tankfo$cesspool per-mitted if_public sewer,i;available within 200 feet.) p Tank- Distance n co r art cares-.___-Z on_ _•1.0 - R p _Size__ Liquid Materialsf�1'S: Cew't -- Septic Tank:' Distance from nearest well S� Distance from foundation e l 1 q depth'--A--- ' ---- ---Capacity---I- Disposal Field: Distance from nearest well-. .�I,-_Distance from foundation____t_6--_#'_Distance rto nearest ot line____-r____ t Number of lines-_----_-- - Len th of each•line_� ;- ^ 1 - �. IF g ; `�. y � Width^of`french`. Type of filter material. ,_Xgc_ De fh of filter material-____1_- 11 _ ... p $ --------Total length---=-----�-�- --------------------- Seepage 11 nn 1 Ef V ' Pio: �, Distance. to nearest well-__LD(a._.___-_-Distance from fo ndation---1_Q---------:Distance to nearest lot line._______._-_ e Number of pits___-'?'----- Lining material�__;:'Cti _ -_Size: Diameter--__ 1 s: P - - .�R. yDeptn-------A-6- ------------------ "r V Cesspool Distance from nearest well_________________Distance from foundation _,..Lining material--------------------.----------------- El ( Size: Diameter--------------------- ---------------Depth_-------------------------------- s "` Liquid;C6pacifY---------------------------gals. Privy: Distance from nearest well_____________________ ----------------------------Distance from nearest-building----------. _-------------- -----_- ❑ Distance to nearest lot line-_----------------------------------- ----------------------------------------------------- -------------------------------------- Remodeling land/or ------------- -- Remodelingland/or repairing (describe)_-------------------- ________________________ , =-----------------------------------------------------•----•------------------------------------------------------ `---------------------- ------------------------------- ------------- ---------- --------------- --------------------------------------------- -----------------------------------------------•--------- ------------------------------------------------------------------------------------- ---------------------------- ------- + 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 rul nd regulations of the San Joaquin Local Health District. (Signed) = 4 - ----------- ---------------------(Owner and/or Contractor) � . { p -- q-stze of-lot--l------ n,af sys#em -•----- -- -7------- -- - ----- -----"`---- ------(Title)------ - --- ----- ........ ------ - t fart, showin -in-relation:fo_.w.ells,�buildings„etc.,-can berplaced_on_r•everse side}. c FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY -------- ---------------------------------------- DATE-----�-- } f� .s� 1 REVIEWED .BY.------------------------------------------- --------------------------------- ------------------------------------- -. DATE------ ----------- - BUILDING PERMIT ISSUED--------------------------- -------- -- ---------------------------------- DATE--- -- - ----------------------- Alterations and/or recommendations____________________________________ ---------------------------------- ----------------------------------------•-- ------------------ -----------•------------------------------------------------------------------------------------- ---------------- --------------------- - ------------------------------------------_______________ _ FINAL INSPECTION'-BY�`�.-0_.-tom ---- �- - _ �. � � , „ �•„ f-rl --- �-5- --------�- SAN JOAQUIN LOCAL HEALTH DISTRICT y ~ 1601 E.Ha:ellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F,RCO. r