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FOR OFFICE-,USE: - r ------------------ ------------------------------------- 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 the work herein described. This application is made in compliance with County Ordinanc:q No. 549. JOB ADDRESS AND LOCATION-- _ I~I [ f\) J_t t�--------L-© ----- Fk --n!----- ------ = Owner's Name----------------J_nj f ! - —;;ltv-Ak-E ------ Phone--------------- Address-_ ....• a �� C----------------------:-----�--- -----------fes 7------------- ------------------------------------------------------------------------- Contractor's Name------ A�F-F's-- ---------------------------------------------------------------------------------L- Phone----------------------------------- Installation will serve: Residence Apartment House [:] Commercial E] TrailerCourt E3 Metal C] Of her [3Number of living units: --- --.- Number of bedrooms _ " Number of baths -/---- Lot size ... '^` ' Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ---- fft. Character of soil,to ardepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam;❑ Clay Loam Clay-' Adobe ❑ Hardpan �] �-W 0 fi Previous Application Made:—(If yes,date---------- --- } No D—New rGonitruction: Yes E] No ®`r FHA/VA: Yes ❑ No ®f TYPE.-OF-INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T I 5eptic�T• nk: Distance from nearest well-----.J~.__�_:_Distance from foundation--.-_.f_LJ..____.Material-'CV��.�-�-i-_. No. of com artmen s-_---. �� LJ P --- Liquid depth- e's..- CapacitY Disposal .ield: Distance from nearest lwell_.__,��aesDistance fro foundation----�Q--.-_---.Distance to nearest lot line................. `N I Number of I;nes___.-�---.-.-.��K�V��Lengt�i of each .line----�0_�I_-�`�__.-.Width of trench.---- .-.---= Ar_.._____.. y' Type of filter mate ial��--- '�. 1 Depth of"" material----- -- -------------Total length--------- --_ :---�---------------._- Seepage Pit: Distance to neare)well----------------------Distance from foundation---------_-_----__-.Distance to nearest lot line-----.-_-__.-__.- 'S �' P ❑ Number of pits---------------------Lining material--------.-----._--fl-Size: Diameter.-------.-----.-----_=-.Depth---------------------------__.--- S Size: Diameter.-----.----- i Cesspool: Distance from nearest well-.-------------- Distance from foundation--------------------Lining material-.____-....._-.._.____---.-.------- ❑ - - ------ ---.. Depth----------------a------ �`=---------------------Liquid Capacity-------------- -- ----gals. � Privy: Distance from nearest well......:....:. ..�..� r____�_t..TI- ._Distan from nearest building._-.-.-.-..------_.--.-_------..---.-----. ❑ ".. -�,aD.istance to nearer `lot IEne. -----------------•- ----------------------------------------- ----------------------------- Qw �= Remodeling and/or repairing (describe):--------• - ---------------------------------------------------- •- -` -------------------------------------------------------- ---------------------------------------------------------------------------- --------------J1------------------------------------------------- -------------------- ----------------------------- -- ------------------------------------------------------------------ ------------------------------------------------------------------------------ I hereby certify that I have pre pared:this�application,and_that=the-work•will4e;,done in accordance with San Joaquin County ordinances, Sfq-te laws, and rul s*an regulationsmofxthe.San=.:JoaquimLocal�.HeaIAhrjistrkct. 21 -`oh--:(Signed)---------- ---- - ------ - � -- -- - -- i .< � ----------- =-----=----- '--''-------(Owner ant/or Contractor) � ) By: - --------------------------------------------------- ------------------------------------------------- ---:----(Title)- ----------------------------- ----- --- -- --- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:, can be placed on reverse side). FORwDEPARTMENT,-USE-ONLY - 1 APPLICATION ACCEPTED BY BATE a 7 REVIEWED BY------------------------- ----- '------------------------------------------------------------------------------------ DATE----------------- ---------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------- ------------------------------- ----------------- DATE--------------------------------------------- --------------- Alterations and/oi• recommendations: y----�- --------------- ------ •-- ----------- ------------------------------------------------------- Y------------ EI;r� IN :jtpi t;1.tt. ------------ ------------------------ ------------------------------------------------------------------- ------------------------------------------------------------- -----•---------------------------------------------- -----•------------------------------------------ ----•- --------------- --- --- - --------------------------- ----------- - - - - -- ----------- -- ' -i -----------------------------------------'--------- ---- ------------------ ..... -- ----------------.- FINAL INSPECTIO Date----------------tP /0s]—f ---- ----------- . t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasetton Ave. 30D West Oak Street 124 Sycamore Street 205 West 9Th Street r Stockton,California Lodi,California Manteca,California Tracy,California F.p.Cil. 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