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FOR OFFICE USE: ------------------------------------------------- --- ------ ------ APPLICATION FOR SANITATION PERMIT Permit No. _pd" ----------------------------------------- --- --------- (Complete in Duplicate) -------------- This Permit Expires 1 Year From Date Issued Date Issued Ly 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. JOB ADDRESS AND LOCA710N _n_ ---.------ ` Owner's Name-------A-, -4-----�-•-,-k, --------A) ---•-------------------------------- p �l ------ Phone..----I;e-r- -Ff--K- Address------------------��3 ."(+ uGei r ' o i 1 I..P trt `f. Contractor's Name------------ ------ --- ------- - --'------------- ----------------------- Phone--------------------------------- Installation will serve: Residence Pq" Apartment House E] Commercial [-] Trailer Court ❑ Motel ❑ Other E]Number of living units: _-_-I Number of bedrooms _.�.. Number of baths .�-____ Lot size ._-_--- _______________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam eClay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.f___.._...__ ..I 'No [ New Construcfion: Yes ❑ No I9' FHA/VA: Yes ❑ No Er- TYPE rTYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:/-t j,,Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------_...... y Size-------------- Liquid depth--------------- --------._Capacity Dispas Field: Distance from rnearest well--- . . _Distance from foundation. __..Distance to nearest lot line___ --- Number of lines______.___ti.;..a�__.__._______ ength of each line--------: . _. KrL -Width of french.__._...-��-�!-___._____ Type of filter material____ .r4e_Abep#h of filter material-_... _ -'7.- Total length----------- -------------------- Seepage Pit; Distance to nearest well-----------------_____Distance from foundation--------------------Distance to nearest lot line----------__.._ } ❑ Number of pits-. ......._._.------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-------_---------Distance from foundation--------------______Lining material-------.------------------------------- ❑ Size: Diameter--- ---- -------------------------Depth--------------- ----------------- -----------------Liquid Capacity----------------------------gals Privy: Distance from netarest well_.•____--------------_-----------------_----------Ditfance from nearest buiidin ❑ Distance to nearest lot line= --------------------- --------------- Remodeling and/or repairing (describe}:------- � -i7�/ �l-�S/-1 r1� � ------ V' ---------- - ------------------- c _ ---------- - - ---- --- - I hereby certify that I have prepared this application and that he work will be done iri accordance with San Joaquin County ordinances, ate laws, and rules and regulations he San Joaquin Local Health District. 1 (Signed)--- r � ----------------- -----------------------------------------(Owner and/or Contractor) By:--------------------'------------------- --------•--•------------------------- -------------------(Title)-------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- ----------------------------------------- DATE. --- ---- -------------------------- REVIEWEDBY -------------------------- --- ------------------------ - ------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ----------------------------------------------------- Alterations and/or recommendations------- -------------------- -------- ------------------------ ---------------------------------- -•----------------- ---------------------------------------------------------------M--------I---------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------•----- -- --- -- - ------------------------------------- ---------------- -•---- -------------------- ------ --------- ------------------------- ----- FINAL INSPECTION BY:.----- G `- �, / ----- Date.---------- f � ��---I -------E.��( .-- "tel �-- --------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California r Manteca,California Tracy,California F.P.CO. -