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FOR OFFICE USE: --f- Y t I0`f -- --- ;, +. APPLICATION FOR SANITATION PERMIT Permit No. ------------- -- --------------------- - ----------- Cam Duplicate)late in (Complete 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 descrbed.J This application is made in compliance with County Ordinance No. 549. \ JOB ADDRESS AND LOCATION...k-CG-L- --`-- A- - � - � -------- --9--- .-----------------S - J--------------•------------ Owner's. Name----- .i �--------- �.t � ------------------------------------- Phone------------------------------------ Address------- -•----------*. --------7E>-------------SA-------------------•--------- -------=----------------------------------------------------------------------------------------- Contrac:tor's Name--------0 Vj-14-�--- -----------------•---------••-------------------------------- ------- ----------------•----------------------- Phone--------------------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A__ - Number of bedrooms 7!n._ Number of baths __1-.-_ Lot size ......XAZ.,S__----_________________ Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z[ Hardpan ❑ Previous Application Made: (lf yes,dole-_----.. --------- ) Non New Construction: Yes IQ 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.) tt Septic Tank: Distance from nearest welL.l' f? --Distance fromlfoundition-__�_b-__..._.__.Mater�L _ _t.v_!�_Ot '____ No. of compartments----- .z- Liquid -----------Capacsty_-aa_Q__,5P4k. Disposal Field: Distance from nearest well_id_Q_h ._Distance from foundation----1_ IDistance to nearest lot line__ -_______ Number of lines--------- -------------- Length Length of each line---------- --------_.Width of french------ ------------- Type of filter material.�_._kp4KL-_-Depth of filter material------� 4��____-Total length---------Ct4_____________________.__._ Seepage Pit: Distance to nearest well__AGM� .£------Distance from foundation----!_b._--------Distance to nearest lot line__.-5-__-___.__ t Number of pits---------t............Lining material---5-0,.-riot. Size: Diameter._,.� � __ .6.. S _...__.Depth----.J(}-- ------------------- r 17► Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.___.__-.._-.--_______-__ ❑ Size: Diameter---------------- ----------------Depth--------------- ---------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest ------------------ -----_---------------Distance from nearest building--------------------------- El Distance to nearest lot line -----__--�..�.----------- ------------------------------ Remodeling and/or repairing (describe): =--------------------------------------------------------------------------•------------------------------------------------------- ------------------------------------------------------ -------- - ------------------------------------------- ------ ------ -------------- ------------------------- -------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County N ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - ------- ------- __._.__{Owner and/or Contractor) + By:----------------------------------------------------------- ------------------ ----------------------------------------------LTitle)--------------- -----------.--- --- -------------- (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---Q--_- --------------------------------------- --------------------------------- DATE--j2--r-3_,_(9i------- ---------------------- --- REVIEWEDBY----------------- --------------------------- ----------------------------------- ----------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------------------------------I—-------------- ----- ------------------ DA-TE------------------------------------------------------------- Alterations and/or recommendations:---1-l--- U_iAe.t-----:_..1�r----t- S-- ---------------D4=- ------- c --------, >v�s. ----------------------------------------------------Z 0;k -- ------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- -. FINAL INSPECTION BY:.- �4 _- - - f -Date 2:'..- f- -' -, SAN JOAQUIN LOCAL HEALTH. DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.