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FCR OFFICE USE: :.............................. . - ......� - Permit No. .�.� ..........._ ........... . .. - APPLICATION FOR'SANITATION PERMIT __...._._._.__..- ---•--------- ----------- (Complete in Duplicatel Date.Issued -r-_c.�---- � - •• _ --. This Permit Expires 1 Year From Date Issued �t Application is hereby made to the San Joaquin Local Health Dis+rice for a permit to construct and instal;the work herein ascribed. This application is made in compliance with County Ordinance No. S49. rho E, j A JOB ADDRESS LOCA ION. ijx' : ./-�- ---..... ----------------------------------- Owner's - ... -•------•---- Owner's Mame. .. - ........... ........... . .----_._. h Addre .. ..�Contractor's Name--. ---- ---- ---- --------•----- Phone............................. .. .. R- Installation will serve: Residence F1Apartment House ElCommercial [I trailer Cour} E] Motel ❑ Other I _ Number of baths _3""Lot size ............ ...... ---- .... t Number of living units: .--. Number o bedrooms . _ _ _ - �f�--_---�.-----T,-6 Water Supply: Public system ❑ Community system ❑ Private !`j Depth t Water a le Character of soil to a depth of 3 feet:`Send ❑ Gravel ❑ Sandy .Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.. .._. ....� - ) No ❑. New Construction:_ Yes ❑ Nc ❑. FHA/VA: Yes ❑ No E) i jYPE.OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ro Septic Tank: Distance from nearest wet -------- ....Distance from foundation_.-._ _---M al_:....;_ No. of torr parrmen+s- Size - Liquid oeptn .......... .......'apac;tY ❑ — Disoos field: Disian�e from nearest weil...l�./t-Distance from founda;ion..-_10.1........Distance to nearest lot/line.�.-____.._.. A I Ler. th of each line.......SO-_'_--_.--.-- -.Width of trench- ..-_...- _---•---•-----. . Number of lines.. ......... ..._ , - - 9 Type of f.iter material............. . .._Depth of filter material-----f....-......Total length--- o---........-......... . ......... Seepa e Pit: D•stance to nearest well.-._.100 .�----Distance from foundation.....1Q .__..._.Distance to nearest lot line..s........... v Number of pits-__--- ---.. -...-.Lining material....-_.`c'. :-- S:ze: Diameter_._ . ~ _Depth._'�-t� -----------------•-•- Cesspool: D stance f;-on nearest well................_Distance from foundation--.-.... .........Lining materia?........-............................ � Se_ D'amater----. ........... .Depth------..............--•-----_--_-. ----------- --Liquid,Capacity- -------------- Privy: Distance from nearest well .............................-........... ,...Distance from nearest b.1 ing _.............. F] Distance to nearest lot line. .......... ... ..._---•-.---•---------•-•-- ....................... I - ...................... Remodeling ar.d/or repairing (doseribel:-... -. . _ --- ��2�� .............. - �...__ - ----- - ------ - - --•--- --------------- ---- ...................... . 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 n rules and regulations of the San Joaquin Local Health District. --- ............ .. (Signed_------ --.- --------...._...._. .. Y - - ----.......... _ -- ---: r r �� -�.; .ALF ---(Tit e)---.-_- --••------------r-•-•------- -- and/or By:----- ....-_. - --� . . - ..... ....-.__._..._... (Plot plan. showing size of lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4 .. - APPLICATION ACCEPTED BY..- :.... xDATE--4. .3-rG 7. .............. ........ t_ ...._. ._ DATE----- _.-_- _------ ___-_ ---•----------- REVIEWEDBY ..----------- ----..................................:. ........... .......... _ ............................. . . BUILDING PERMIT ISSUED- ---•-- -------•-----•----- .. ........................... ....... -_ - DATE ....-- ..... .............. .............. Alterations and/or recommen ations:.. ...____..._....._...-.... ................ -----•----•--• ......._.._------•---------_-•- - --•-•................... ........... . FINAL INSPECTION .--!- - Dote._.6-._�Z._i1-."-1.�. . -..... .-•------------ -----------------INSPECTIONBY:..-.� . .. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Californle Manteca,California Tracy,California F.P.CO.