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FOR OFFICE USE: ----------- ---------- ------- Zitv __ -.- 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 o. 549. JOB ADDRESS AND LOCATION;-_ex?+ -----/f%' 1 --------------------------------------------•------------------- -- Owner's Name------ f es'fr/_ .�L � _ ---------•------------ ------------=------------ Phone--------------- ----_------------- Address--------- a_. _c ---------------------------------------------- ----------------------------------------------------.------------------------------------------•--------------------•--------- Contractor's Name------------- f ------ '"- Phone Installationwill serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑, Number of living units: __L-__ umber of bedrooms __J?-'-__ Number of baths J--- Lot size _ `�f 6� =-------------------------------- Water Supply: Public system Community system (_1 Private E] f Depth to Water Table _�Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z3--_H ardpan ❑ Previous Application Made: [If yes,date--------------------) No M-- New Construction: Yes ❑ No E4- FHA/VA: Yes ❑ No P-- { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) Septic TanL Disfance'.from nearest weh-----------------Distance from foundation_:------.----------Material---__-.._-__--_---.-.-_f1___-__._-.-----___-. �.' -16 4!'7� No. of compartments --------- ---------- - Size--------------------------------Liquid depth-------------------------Capacity':•------------------- Disposal Field: Distance from nearest well.-..--------Distance from foundation.-/,"p-__-._--.Distance to nearest lot line___---__._- Number of lines__________ ____ Length of each line___, __.----_._-Width of trench. ._____;_.__._____..___..___ 9 y f �.. Type of{filter, material-�v--Depth of filter material:_1 _.____ _.. Total length--- ------------------------ Seepage Pit Distance to nearest well....-_`---___..._--Distance from fou dation.3_�---_-_.Dista�e to nearest lot I e_'-__!W---_ y�'� Number of pits-.-- --------------- -Lining material---- .Size: Diameter._.r3.1..-- ---Depth., _/ :-.. Cesspoo : Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter-------------------------------------- -------------- -- -- ---------------Liquid Capacity- --------------- -------gals. 1 ` Privy: Distance from nearest well------------------------------------------ -----Distance from nearest building------.._-.--.-_----_-_--.----.---__-.-.-. ❑ Distance to nearest lot line------------------------- -------------=------ -----------------------------------------------------------------------_--- ----------- Remodeling and/or repairing (describe):--------- - - �l�°l� r ------------------- ==--------------------=-----------•------------- -------------- -------------------------------- ------------------------ ------------------------------------------- - ----------------- I---------------------------------------------------------•--------------------••----------------------------------------------------------------- ---- ---- ---------- - --- - --- 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 and regulations of the San Joaquin Local Health District. /� / (Signed) ,��'��'�� `� �" �` C` ----------------------------------------------------- --------------------- -- { Con----- or) By:---•------------------------------------------------ - _--------------------------------------------(Title)---- -- - -- (Plot plan, showing size of lot, lacatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATIONACCEPTED BY---- ------- C -------------------------------------------------------------------- DATE------ { ---------- ----------------- REVIEWEDBY--------------------= ----- ----------------------- ----- DATE---------------- ------------------------------------------- BUILDING PERMIT ISSUED I ------------------ ----------------------- ------------- DATE.-------- ------=-------------------------- -------------- Alterations and/or recommendations----------- ------------------ --------------------------------------------------------•------------------- ------------------- ---•------------------ - ---------------------------------------------------- FINAL INSPECTION BY:..... -� �`� Date------------------- ---- ------------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ,^ .. ,r i w 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.