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0 FjK Ul-l-K 1: USt: ` ��----------------------- 114, ----------- - -- ,. -_ _ __-__________________________ APPLICATION FOR SANITATION PERMIT Permit No. .__L. 1.��... �! fl- --------------------------- ------------------ (Complete in Duplicate) Date Issued ---------------- This Permit Expires 1 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. JOB ADDRESS AND LOCATION--- -- - ----- J--- . u--�<-i--All" ---lull----------------------------------------------------------------- Owner's Name--------------------- -- -•--- - i �l/,�0 r ----------------------------------- Phone.� ' '. � AddressZ`' .J_ /- --R--•-'V—-----------------••----------------------------•--•--•-•--••-------•----------- •- Contractor's Name f G------------------------- --------- Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: � Number of bedrooms _-ok_ Number of baths _/__ Lot size _____ X---1..)�___------------------------- Water Supply: Public system ff'-Communitysyst&m ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ig-O'Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date--------------------l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ___...._______-_____._____-,______...____.___.. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-••-------------------- Disposal Field: Distance from nearest well-------- --------Distance froni foundation_____--------------_Distance to nearest lot line----------------- El Number of lines--------------------------------.--Length of each line-----------------------------.Width of trench.------------:--------------------- 00 Type of filter material_________________________Depth of filter material-------------- ----- Total length------------------------------------------ Seepag Pit: Distance to nearest well------ .--------Distance fro foundation_.2-7".___.Distance to nearest lot line-_3r+?_-'__ N Number of pits---------/ .- ___Lining material-- __.. Size: Diameter____ �`" -Dept h-..r?.SS_.`__________________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining - material-----_-_________.._._______________-_ ❑ Size: Diameter____._.._ -------------De th______--- -- ----- --_- - - -- � -Li Liquid Capacity-- ------------------------gals . Privy: Distance from nearest well---------------- _------------------- -.---...._Distance from nearest but{ding------.------- -----._---------------__--- ❑ Distance to nearest lot line--------------------------------------------------------- ------•----------------------------- --------------------------------------------- Remodeling and/or repairing (describe):------------ -��._._t�.---_------ATL?-------E, -��- ��jl, '-- , ,1 -.--------------• G 9 ---------------------------------------r---------------------•-------------------------------------------------------------------------------------------------------------------------------------- ------------------------- --------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- - --I------------------------- I hereby certify that 1 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) ---- -��----- --------------------------------------------------------- ------- w r and/or Contractor) By--------------- ------- --------- -- ------------------------------------- -----------------------------------------(Title)---- � s------- -- (Plot plan, showing size of lot, locati n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- r'.. ------------------------------ ---------------------------------------- DATE-------- -------------- REVIEWEDBY--------- ----------------------------------- --------------------------------------------- --------------------------------- DATE----------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------_ ------------------------------------- DATE------------------------------- ------ --------------------•- Alteratis an /or recomme daf ns: ------------------------------------------------------------------------------------------------------------------------- -- 7. -----------------------------_ ------------------------ ------------------------------------------- -------------- -- `z"7 `� ;;e )----•---J----------- --•`---------------•---------------•--------------- - ky. G s - �:'--- ----- -?`�_--------------------- -- FINAL INSPECTION BY:...............(:.. Date - ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.