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FCS OFFICE USE: / / ��1----- ------------- - � . . .5 -- ---------------- --.4)20p--. APPLICATION FOR SANITATION PERMIT Permit No. a f �- ----------�� —. (Complete i licate) Date Issued ..............----------_..--------____.._..._..__ This Permit Ex fires 1 Year rom Date Issued ,r+ 'I Application is hereby made to the San Joaquin Local Health Distric for a permit to construct and install the work herein described. This application.is.made incompliance with County Ordinance No. 549. 7,0 6cle-4e-F-77W JOB ADDRESS AND IO , N.."f.l- _f,- S -- Owner's Name------- 1lI� --�_ . Phone----• -------------%---------------- Address------- -----•-Address_ --�' ------09------ � - ------------------------------------ Contractor's ----------------------------------- Contractor's Name------------ -/ , ---- Prone------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/r----_ Number of bedrooms_.. Number of baths _/_ Lot size r _`____________________ Water Supply: Public system E] Community system E] Private Depth to Water Tablett. Character of soil to-a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V-�ardpan ❑ Previous Application Made: (If yes,date--------------------) No 99--INew Construction: Yes 76--go ❑ FHA/VA: Yes �' o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest w I-_-b?C1-----Distan e f/ro`m f undation-40-AP-----.MaterialC .�/eP�, -------------- No. of compartments _ / Sizeti ffG�7-t ,�Otquid defth__ _________________Capacityyl rss�� ___ Disposal Field: Distance from nearest well_�Q----.-Distance from foundationA0---_.------Distance to nearest lot line-?0--_..._. L [�' Number of lines._.__ _.. ._.__ f�ength of each line._._ Width of trench--- --� ________________ Q Type of filter material-- ___ G/�Depth of filter materiaL_..�� _____Total length---1 ------------------------ i Distance f m fo dation-_f is nce to nearest t lie Seepage Pit: Distance to nearest well.... Q�._ j � Number of pits-. l-------------Lining material_�e .Size-. Diameters? ��-----_Depth --- Cesspool: Distance from nearest well-----------------Distance from foundation------._.-._---.--_Lining material_____-------------------------.---._.- ❑ Size:. Diameter--------------------------------------Depth------ ------- -------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well----------------------------------------------- from nearest building ❑ 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 ordinances, State laws, and rules and regulatim of the San Joaquin Local Health District. (signed) ----- ---- -- � r Contractor) BY---------------------------------------------------7i - --------------------- --- - --`'------(Tiile).-F ✓---------------------------(Plot plan, showing size of lot, location stem in relat' to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED;iBY -- t------------- -------- ------------------------------- ---- DATE fw� REVIEWEDBY------------------------------------------- ---- ------------- -------- ---------- -------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------- DAT . QAlterations and/or recommendations: ------------------------------------------------------ /.�----. i -- ----.-.----- ----- -� ----------------------------------- I - ------ ---- ------------------------------------------------------------------------------------------------------------- FINAL ------- -----------------------------FINAL INSPECTION BY:---- - Date---------1 `................ ---------------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT a 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Montecar California Tracy,California E