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FOR OFFICE USE: --------------------------------------------------------- --- --------------------------- -------- ---- ------- APPLICATION FOR SANITATION PERMIT Permit No. _a,-1., .: (Complete in Duplicate) Date Issued --------------------_---______ -------------------------- This Permit Expires 1 Year From Date Issued OSt—f&o-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. x-73 O Al. " ► . .. JOB ADDRESS AND LOCATION- - - --- DX/rTQ--< "--- --/ll .�_�Y -"__Y%_ A�''_% 1 " Owner's Namec�.�C° _/ ... sa0/�-�- = ------ / Phone- Address -•-------.-- ®'A� f6> � � •---- ----------------- Contractor's Name----- !J'` � '01r phone- --Installation will serve: Residence B---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/- _ Number of bedrooms __�_ Number of baths _Z.__ Lot sizea_t`'___________________ Water Supply: Public system ❑ Community system ❑ Private Ga,,,6epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ~ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No E]—New Construction: Yes ❑ No (:] FHA/VA: Yes ❑ No ®r 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 weli_11_ ___Distance from foundation__!?W__/....Distance to nearest lot line__ ..._ "_. I� Number of lines----- Length of each hne___3p__�!.--------Width of trench------a_ _ _________.___- Type of filter material__ /fsp '___Depth of filter material_—•. `�_-__-Tota! length--- U S ' Seepage Pit: Distance to nearest _.........Distance ro foundeltion___' �- ____.Distance to nearest lot line__ --- ``'_----- ' �Number of pits----_�_-- ------Lining material-/��.Size: Diameter.:___ Dep o .�> V Cesspool. q\r\ ' Distance from nearest well-_-__--------_-Distance from foundation-_________________ Lining material___.__.._-_-___..__.____.____.____.._. Size: Diameter---------6--------------–---------De th_-_----------T`�------�F----------Li Liquid Capacity gals. Privy: Distance from nearest well____ _-.-""'._______________.............. ..Distance from nearest building----------------------------------------._ ❑ Distance to nearest'lot.line________________________ " � . I. �- F-- ,.� / � Remodeling and/or repairing (describe)=-- -- -- �-- -___--� --___-.��---.�`��--------------- i�1------------------------------------------- ----------•---------------------------•-----------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- -- z ------------------------------------------------------------------'-------------------------------------------------------------------------------------------- IqA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the wor 'I be done in accordance with San Joaquin County ordinances, State laws, and rules and re tions of the San Joaquin 'oc Health District. (Signed) -----------�--------- ---(Owner an or Contractor) By:--------------- ---r------- ------------------------------------------ (Plot ----------------------------------------(Plot Elan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). IFOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY - - --011 ---------------------------------------------------- DATE_13_' _".G--------------- ---------------- REVIEWEDBY------------------------------ ------------- ---------------------------------- --------------------------------------------- DATE----- ----------------------------------------------------- BUILDINGPERMIT ISSUED----------------------- ------------------------------------------------------------------------- DATE-- ---------------------------------------------------------- Alterations and/or recommendations:.------ --------------------- ---- ---------- - -------------------------------•----------------•------------------------------------------------------------- -----------------•--------------------------------- ----------.-._...------------------------------------------------------------------------------------------------------------------------------------------- ---------- ---------------------------------- -----------------------------------------------•------------------------------------ ---------- -------------------- ---------------------------------------------------- ---------------- -------------- - -------------------------- ----------- ------ -------------------------------------- ----------------------------------------------------- -------------------------------------- FINAL INSPECTION BY _ - Date_:.. .r-Z ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.