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FOR OFFICE USE: �3�(0r--------------------/_/--0-°------- APPLICATION FOR SANITATION PERMIT ------------- --- ------- - ----------------------------- i (Complete in Duplicate} Date Issued !-- -� -------------- t1 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 de rbed. This application.is made in compliance with County Ordinance No. 549. 1 eq-!&0-06 go q a D 0 i.�l_• ILf01.ri+�1/�'+a 6Q+� ;Ze JOB ADDRESS AND LOCATION /__z'1 ----- � " Owner's Name--------- Ph - ------��_G�f'(�._'��-j----------------------- ----- ------ --------------------------- - --------------- one-------------- ---------•-----••---- fAddress---------------- - '- ---�-----. ----- '-?� - --- •�;� -------� - - -- - -!�-----------------------------------•------------•--------•------ Contractor's Name------- ---------------------- -------------•--- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑• Other ❑ Number of living units: _./-- Number of bedrooms -/- Number of baths j--- Lot size _- 411`--e-Af e--- •------------------------ WateriSupply: Public system ❑ Community system ❑ Private Depth to Water Table -7- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E] Previous Application Made: (If yes,date__---_ _ [R09--NoF-1_ .,__..,._.} No I New Construction: Yes No FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ell O i l AeO_ Septic Tank: Distance from, nearestwell_/.�j0___Distance fr m foundation___ e...---.Material + ' No. of compartments__-_ -_-------------Size ---�� Liquid depth_-. �-- Capacity_ -- fIf i �P--__.___- Distance to nearest lot line--- Field: Distance from nearest well./L�,-___Distance from foundation__ -_. __ l �I � i [� Number of lines___-___ ---- - - -------- Length of each hnef—_.-_�p<01------ of french .-____._j_...-.-.___..__ f Type of filter materia � Depth of filter material..-es -- 9 Total len th--= ------------------- Seepage Pit: Distance to nearest well-----_----------------Distance from foundation------------------- Distance to nearest lot line____-_______-. iNumber of pi's----------------------Lining material------------- --- ----:Size: Diameter-----------------------Depth-------------------------------- Q Cesspool; Distance from nearest well-________________Distance from foundation--------------------Lining material---------- -------------------------- El Size. Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity------------- --------------gals. Privy: -'DDistance from nearest well-------------________________________.---------_ istance from nearest building----------------------------------------_. rt fi ❑ ---•-_ =---------------------------- Distance to nearest lot line.----_-------,----------- ------------=-_-_-''�------=--_ ---- Remodeling and/or repairing ,k5z- ._' --- = = ------ A. __________________________________________________________________________ --------------------------------------------- -------------------------------------------------------____________, __-____________ ________ _S_ _T y �_y______________ __ j__--_______________-_-_______-________-____- __ } 1 ----------------- t ----- ---- --------------------------------------------•------------------------------------------------------------- I I hereby certify that I have',prepared this application and that the work will be done in accordance with San Joaquin oun y ordinances, State laws, and rules(andtregulations of the San Joaquin Local Health District. * ¢+ l (Signed)---------------- � r'. = ( - Contractor} 1 �=�" --- -sem- --- ---�--------- - --- --------- ---------- - - -�----- j�. (Title} L �� _� ---------- •------- -------------- . (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- '- --- --------------- -- ------------------------------------ DATE ' _) -�. } - --- --- --------- BY-------------------------------- ' -f "------------------------------------------------ DATE DATE--------------------------------------------- BUILDING PERMIT ISSUED---------------•-�---------(- - --- -- ----------- Alterations and/or recommendations- -------- -------;------------------- -------------------------------------------------------------------•------------------ ------------------------ �. ----------------------------------------------------------------- -------------------------------- ------------------------------ --- ---------------------------------------- ----------------------------- --------------------------------------------- ---•------- - -------------------------------------------------- ---------------------- ------- ---------------------------- 3 FINAL INSPECTION BY':... ----- 1-�'�-�- Date.------- ------------------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hasollon Ave. 304 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California .vx �'Manteca,`California Tracy,California