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FOR OFF CE USE: �f ---A- ------ APPLICATION 'FOR SANITATION PERMIT Permit No. .. ___ _`�..__ ------ -- ----------------------------------------------- I - Com 1ete,in.Du hcete . . .{ p p' I. .� ,.. .�_>.. — - - Date Issued -----------------------------------------------------._-_ f 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. ` JOB ADDRESS AND LOCATION.> _ a-- �' = I --------------- -- ---------- Owner's Name----.Ck.nLJ�,.-----4, -------------------- ------------------------------------------------------------- ---------------- .. Phone. 4 -4,--.�.�-�- � �Address _ . 3---- -•- •---•-------- •----•------•---- ------------------------ t. , Contractor's Name-------- -- ------------------------ = ----------------------------•- - ---------•-------------------------•--•-- Phone------------------------- -•------- Installation will serve: Residence If Apartment Housel ❑ Commercial ❑ i Trailer Court ❑ Motel 0 Other ❑ f r Number.of living units: ------Number of bedrooms _--, _ Number of baths -1----- size ------ ________________-____ Water Supply: Public''system Community system ❑ Private ❑ .Depthl..to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ .Hardpan ❑ Previous Application Made:_ (If yes,date--------------------),,,:N o ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: X i P (No septic tank or cesspool permitted if public sewer is available within 200 feet.),, Septic Tank:. Distance from nearest well--------------"-_Distance from foundation.--_!0_____-_.Material..._ ___ _____._____._..___________.._____-__._. �3. No. of compartments_..__-�...............Size--3.x_S7�_[,0-------Liquid depth-------------------------Capacity--10-_4_.a- --- i / Disposal Field: Distance from nearest well______--____...Distance from foundation--- to nearest lo� line_____ _________ �J Number of lines-_ .. .------ Length of each line__-__��_ _-a�_____-.-.Width of trench`'__`,-_____ _______._________ f Type of filter mateiial__ G _1 -______Depth of filter material---- _____"-___._._Total length_a__I:/__ °______________________ Seepage Pit: Distance to nearest(well____________________'6stance ffrm o �foundation____________-_____. no n Distance to lot line------------------ A -4 El Number of pits-------(--------------Lining material-------`__-_-- _ _--Size: Diameter-----------------------.Depth------ -__------------------- O Cesspool: Distance from nearest well_________________Distance from foundation___._:.___._____....Lining material--__.__--_-____._..__..___.________-- ❑ Size: Diameter- --I- Depth------ I-------------------------------- Liquid Capacity gals. 6 A II•' Privy❑:. Distance from nearest well------------------------------- --------Distance from nearest building--i_t------------------------------------ Distance to nearestlot line---------------------------- ---------- ----------= Remodeling and/or repairing (describe):----- ----------------- ---------------- ---------------------------------------------------------------------------------------------------- s , 1 1--=-------------------* 6 ' k} € -------------------------------------`-------------------------------------------------------------------------------------=---_---------•----------------------------------------------------------------------------------- Q ------------------------------------- ----- # f------------ I---- 1 I hereby certify that I have prepared this application and that Ae''work will-be done in accAance with San Joaquin County �. ordinances, State ws; and rules gulations of the,San.Joaquin Local Health District. �* Y ),fC -"-- ---- __________________ti_ _...Owner and/or Contractor (Signed)----- F ( / ) By:----------------------------------------------- '------------------------------------------------ -- " -- !(Title)--------- --------- - ---- (Plot plan, showing:size of lot, location of system.in,relation to wells, buildings,.etc.,.can be,placed on reverse side). r.- j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -_.- -r-- ------------------------------------------------------ l�~ � ~ DATE------------------------- -- - ----- ----- -- -- --- REVIEWED BY-------------- ------------------------------------- ----- DATE------------------- BUILDING PERMIT ISSUED------------------ ` ---L---------- — ------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:---==---- -- ------T-- --------------------------------``r-----------------------------•----------------------------------------------- -------- ------------------------------------ ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------•---------------------------------------- ----------------------------------------------------------------------------------------------•---------•-------------- •------------------------- r --------------------------_---------:----------=----•--------=----------.-.------...--------------------•---"---------------------------------`-------------------•-----------•------_-------------------•-------.._...- -- - - - - -- --- - --- ---------------------------------------- FINAL INSPECTION BY:. ------. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVIS EC B-59 3M 3-'63 F.P.CO. w1 •" .•.