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FOR OFFICE USE: --------------------------------------------------------- _____________ __._..______..______.._______-_ APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) i _ This Permit Expires 1 Year From Date Issued GDate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisrapplication,is-ma eA n-compliance with County Ordinance No. 549. , JOB ADDRESS ND bCATION - -e� -r�----_ / --------- I f Owner's Name------ _. - -------------------------------------- .. -------------------------------------- Phone__.-/J v.C: Address-- ------x__.e3' f�` Contractor's Name- !yi'TSL ------•--•--------------------- -------------------------------------------------------------------------= Phone._- .-,-7:R Phone__ R ---••--------- k F Installation will serve: Residence RApartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ tl� . Number of living units: __>r__._ Number of"bedrooms .'3-4Number of baths., ----- Lot size ______________ ___ ------------------------------------- t py Wafer Supply: Public system ❑ Community system ❑ Private �epth fo Water Table _I'_oft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel "�Psancly Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date.________.,__.___.) No 6i New Construction: Yes Pa-1ro El FHA/VA: Yes ❑ No K3-- TYPE'OF INSTALLATION AND SPECIFICATIONS: = (No septic tank or cesspool permitted if public sewer"'is iavailable within 200 feet.) Septic Tank: Distance from nearest well-S-20........Distance from foundation-_1i�_----------Material__._CA'�'' � _--------------- s No, of compartments---._=_�---------___- `A__5F�X-gIiq uid depth____.__-_!__*_- ------Capacity----/A v-0_ Disposal Field: Distance from nearest wells -P------Distance from foundation---1_4?__---______-Distance to nearest lot Number of lines__________ ._ -----------Length of each line__1';�`__�.�-��'VVidth of french----a_._'-__-_ ----------------- Type of filter .materialr7eelir-----------Depth°,of filter materiaL___l�'__________Total length____-_--ste_D--'__-_-_.________ I -- Seepage,Pit: Distance to nearest well f Oa-�--____Distance from foundation__/'_______.Distance to nearest lot line__ 1______ Number of pits. ------------- material______ AZG __.Size: Diameter-_,TC�_y____...___Depth_._._*��__�_________.__ � Cesspool: Distance from nearest well_________________Distance from foundation-------------;------Lining material-------------------__-_______________- ❑ Size: Diameter---------------fDe th''- - Liquid Capacity-:.. als. p q ------------------------g Privy: Distance fromnearest welL___________________________________________ ___Distance,from;`nearest building_,------------------:---------_,_..___.._. ❑ Distance to nearest lot line 11 ----------------------------------- =------------ ----------------------- ------------------------------ r Remodeling and/or repairing (describe):-------------------------------------- -'� ---- --•-------------------- ` _ - - + a ---------------------------------------_____________tiJ__________.__________ --------------------------------------- -------------------------------------------------------------------------------------- .r 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 andregulatio s-of the San Joaquin Local Health District. (Signed)---------------- ----- h -------- - . -- =--------------------------------- ----------------------- -(Owner and/or Contractor) By:------------------- _ --------------------- - ------ =-'--------------------- fle) ------------- _ ---- ` (Ti -.— (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY F - - -------------------------------------- DATE---- _ REVIEWED BY------4✓-h-------------------------}--- ----------------------------------------- ----------------------------------•--- DATE---l�-f --- y~ ---------------------- BUILDING PERMIT ISSUED--------------_------•----------------------------------------"----------------------------------- -DA•TE------------------------- Alterations and/or recommendations-------------------------- - ---------------------------------------•-------------------•------------------------- ------•-•--------------• ------------ --------------------------------------------------------I—----------------------__---------------------------------------I-------------------------------------------------------------------- ---------------------------- ---------------------------------------------------------------------------------- -----------------•------------------------------------------- ------------------------------------- -------- --------------- i FINAL INSPECTION..{3Y:..... '`' -------------- __ Dante- ------------------ 'S '.) 7,� ' SAN JOAQUIN LOCAL\HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ti Stockton,CaliforniaLodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-;83 F.P.CQ. Z.0 �z x