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. ...........-� // ��jj//• -•••--••. .. ... APPLICATION FOR SANITATION PERMIT Permit No—1-.-0._v 7 S_ .................... (Complete in Duplicate) " This Permit Expires i Year From Date Issued Date Issued h 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..-...... Owner's Name................ .......... /+ Address e::9...7- v.......... ��l��rO .t/ Contractor's Name__,............ Installation will serve: ResidenceQ�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�. Number of bedrooms --3.. Number of baths -l. --- Lor size ._.��i./�t�i'��?'.�'... ................ Water Supply: Public system ❑ Community systom ❑ Private (Depth to Water Table .6e74. ._ ft. Character of soil to a depth of 3 feet:'Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[c1/Hardpan ❑ Previous Application Made: (If yes,dote................... ) No New Construction: Yes No I ❑ [� FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well..._-•--„.._•._.Distance from � foundation..- ..... Material.-. ... 'No. ocompartments.._._. --... ......._... .. -' ” ..... ...•....Size.. -----.... ............. ...Liquid depth----....._... ------ - apacify --• I' Disposal Fieid: Distance from nearest we'l._.�_j.- Distance from foundation-.-A,� ,--,� ...__....Distance to nearest lot line.... Lam' Numcer of lines............1. ..................Length of each fine---- .5'..........._...Width of trench.....��..--• Type of filter material.._ �- Depth of alter material... .-/ �s- P �._.-..?eta! length.-----' - •--- -- --- -- -- Seepage Pit: Distance to nearest well_._..�Q�_/�j{�s+ance fro .--- ' foundation .uZ�..... Distance to nearest loft lire. ..... Number of Pits.... . Lining material....$.r Eef''.S; e: Diameter....... �.�.''....Depth.. aZ.5 ........... Cesspool: Distance from nearest well---.--------- ...Distance from foundation....................Lining material............. . ---.... ❑ Size: Diameter....._._.t.- ................ ....... Depth..........._...............---... .._. .....__.....Liquid Capacity..__...---........... ----gals. r Privy Distance from nearest well _... .-.-..Distance from nearest building...171 +o nearest lot line...._....-.__-......... . Remodeling and/or rapairir•g {descrioe): ---0"eox .------...--•---_...---•..................------............--.... ,: - ..........:.................................... ....... -----••---------•-•---..... ........ ..__..... .. . 7 .................. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat . ules and regulations of the Sart Joaquin Local Health District. (Signed).....__..... ~�� By:... .......... ...... ....... ..._ .... r.�', �ja^ r Contract /o ..................... ................................(Title).... (Plot plan, showing size of lot, location o ystem in relation fo wells, buildings, etc., can be placed on reverse side). or — ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... .... V ------ --- --_-_----- DATE.... ....... . ....... ".. .. . s........REVIEWED BY , .......... _-• DATE........................... BUILDING PERMIT ISSUED................................. _.........-.._. JDATE................__. ..._x Alterations and/gr recommendations:....... .... ` """ FINAL INSPECTION' - " // I ... ..........• ---- ••-.C'2��2'�----� Date..... .."-�-- ' SA JOAQUIN LOCAL HEALTH DISTRICT 1401 E.kastrtton Ave. 300est Oak Street 124 Sycamore Street 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California