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FOR OFFICE USE: ----------------------------------- _ .. APPLICATION FOR�SANITATION PERMIT Permit No. ----------------------- = ---- - {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.r,� JOB ADDRESS-AND LOCATION-------- /V- .L�-----------�---a•--------" .P'_!f�? - ---__----------- ------------------------------------------------ Owner's Name-- J, - "' ` :` -�-1_P.-I-C-=-•---- S fcft. r Phone Address------------------------ ----------1�( dQ-1...•---------------------••--•------........---------------_-------------•--' Contractor's Name-----10�------•-- �--- =� --------------------- - - -•--•----- Phone.---------------------------------- Installation will serve: Residence 5 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----t Number of bedrooms Number of baths Lot size ---��-------------------- Water Supply: Public system ❑ Community system ❑ Private UP-0ge—pth to Water Table - ,S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ C ❑ Adobe �ardpan ❑ Previous Application Made: {If yes,date__-----------------I No 2"--New Construction: Yes No ❑ FHA/VA: Yes ®--<o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from.nearest.well__.$7V._ - --Distance,from fou dation__ Q__...___.Material_... ------------- VNo. compartments... Size _ . �_Li uid depth Capacity_--_ 49�-_______ Disposal,Field: Distance from nearest well - �._Distance from foundation---�d-!------Distance to nearest lot line__s__..._____ I Number of lines_________�-----------------Length of each line___kP&---4�-P___ ... Width of trench._!�_Y_. ------_.__.-.-_.- Type of filter material___J.�,4L_----.-_Depth of filter material.-.--I_ ``!___..Total length--_-IS_ __'�--------------------- l See pa it: Distance to nearest well----Iia-- -_--Distance frroom fo�dation___- _ __ --- Distance to nearest lot line---- %A Number ofits.__. Linin material_--- }�-L __.Size: Diameter.__ ./.___De tn__.c �._-___ � ! i Cesspool: Distance from nearest well---------------- Distance from_foundation.-._._.___.___._..Lining material---------------------------------- -- ---- - ' ❑ Size: Diameter_._.. ---- -y ---------.DePt�h--------- ------------------------------ - -- Liquid Capacity----------------------------gaIs. Privy: Distance from nearest weEl__________________ ___ _____ _~._:_�-__.___.Distance fromnearest building._._-._._.___.____________.___.._____._.-. O ❑ Distance to nearest.lot line:_._-- -----` � '~ --------------------------------------------------- ------------------------------------- ---------- Remodeling and/or repairing (describe):`._ , -------- ---- --------------------------------------•-------------------------------- -------------------------------------------------------•---•------------------------------------------------------------ ------------------------------------- ------------------------------------------------ ---- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r 1 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 d regulations of the San Joaquin Local Health District. _` .___...__ .---- --------------------------(Owner and/or Contractors (Signed)---------- ------- ----------------- BY= - ---- K 1 (Title) Q (Plot plan, showin sidZlo�, location of systemnin reatiba-io-wells,,buildings,_etc., can be placed on reverse side). �s FOR DEPARTMENT USE ONLY x E APPLICATION ACCEPTED BY- - --- ---------------------------------------- DATE----------- -•/j.-�_.`_H'-------------------- REVIEWEDBY-------------------------------------------------- ------------------------------ -------------- --------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------- ----------------------------------------------------------------- DATE------------------------------ ------------•----------- Alterations and/or recommendations---- y- - ------------------------------- ------------------- - - " ----------- b`' "�bJ ------ - � r. _. 6 ------------------------------------ .__ --------- ----------------------------------------------------------------- -------------------------------------------------_----------------------------------____________________________________________ FINAL INSPECTION BY:------..0 i---- --- ------------------------------------- Date_---- ��`�T`1�`sr -- -- --- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California' Lodi, California Manteca,California Tracy,California J