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FOROFFICE USE: r -------------- -C�7 �____________________7�'�---- APPLICATION FOR SANITATION PERMIT Permit No. 11�.... -- ---- ------------------------------------------------ (Complete in Duplicate) S l --------------- This Permit Expires 1 Year From Date Issued Date Issued ._'___ �;1-- _ 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 ANPI LOCATION------------------- _/ .....--------------------------------------------- ------------------------------------ Owner's Name-er--------- --- -- Phone------------------------------------ Addres °l`!`c, ------ enc Jlr✓ ----------------------------------------------------------------......----------------------------••-- .. Contractor's Name---- /---------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo`tel ❑ Other ❑ Number of living units: _�,N�er of bedrooms* ---_ Number of baths ___�._ Lot size -_-_-�x 4, __� l�_-K__ 'f__ _ ___.-,- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table __ t ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa Loam ❑ Clay Loam ❑ E] Adobe Hardpan El Previous Application!Made: (If yes,date_...:.-_.....�__ ] No New Construction: Yes No ❑ FHA/VA: Yes E] No �� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se:er is available within 200 feet.) Septic Distance from nearest well...."-__..-_ D;stance from foundation___%Q_f____._.Material _ No. of compartments...-___;._?-- Size__ '_ ----.___Liquid -_Capacity__eO'SJ-.-------- Disposal Id: Distance from nearest well----'"'___..._Distance from foundation----,1GT,_�__-.Distance to nearest lot line_-. ------ Number of lines__._____''' Length.of each line------ ,j`__2- _--Width of trench.._. -y%--------------- 1 ` ��-----Total length------Ap/------------------------ " Type of filter materral.___�,11..-�� Depth of filter material------ Seepag it: Distance to nearest well_-___.—________Distance fro foundation___1ZU_�__.__-Distance to nearest lot lin�47�_____._ dumber of pits.__:-- .....--Lining material______ __-Size: Diameter-___,' -1_..____Depth_..s� =_____-- Cesspool: Distance from nearest well,,._--------------------Distance from foundation._ .____�,__Lining material_____________________________________. ❑ Size: Diameter--------------------------------------Depth-------It------ ------------ -----------------------Liquid Capacity- --------------------------gals. _ Privy: Distance from nearest well_______________________________I ___._____._Distance from nearest building----------_____----.._______ ._. ❑ Distance to nearest lot lire------------------------- ------- ar- �Z5 v "w Remodeling and/or repairing (describe) flay � --------- --------------------------------------------------------------- ---- --------------------------------------------------------------------------------------------------------------------------- --- - --------------------------------------------------- --------------------------------------- -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify_that_I have prepared.this,application and that the work will be_done.in accordance-with San Joaquin County ordinances, St aws, and rules regulations of the San Joaquin Local Health District. (Signed)------ --- -------- ----------------- ------(Owner and/or Contractor) BY: ------ - A ---- ------ - - ----------------------------------(Title)------ {Plot plan, showing size oW,�ocation of system in relation to wels, buildings, etc., can be placed on reverse side). FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -- '------------------- ----------------- ` --------------- DATE--------J -.7 n.---W. REVIEWEDBY------------------------------------- - ----- ------ DATE----------------- ----------- ------------------------ - --- BUILDING PERMIT ISSUED-------------------------------------------------------------–-------------------------------------- DATE---------- ------ Alter ions andjor re,cy 'mendations:--------_._ - '?--4-1------ / f C�- -- S^----- -- ---------------------------- ----- ----------- ------------------ .................. --------------- -- --------- ------------------------------------------------------------------------ ------------------ --------------------- ------------- FINAL INSPECTION BY:. ....C_"_.------------------------------------------ Date.......�� k,5-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California