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F R OFFICE USE: �,/ 7 xy,74-$-----------j.v:-aO------ APPLICATION FOR SANITATION PERMIT Permit No. Jam?; ------ ----------------------- -- ------------- (Complete in Duplicate) cf 'Date Issued ----I.-Al --��--- -------------------------------- 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 �� - Y-�^�......'TU Owner's Name---------- --------:--•-- C og -------- -------1 /t � ------------- --------------------_ Phone- IrL/ c1^/ j � T. ---------- f Address ---------------------- -- - t-•-- - ��-- Contractor's Name--•--=------ x>,e.l " f-r-- ------------ - ---------------------------------------- Phone.- - -.49LnV-46 7 Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { ` - �, N ` ! Number of living units: ---/_ Number of bedrooms .- Number of baths - -.- Lot size ----- _- �_/ -"- ®/�� ------ Water Supply: Public•system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam 5& Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.-------------------] No J New Construction: Yes ❑ No ® FHA/VA: Yes ❑ NojW r' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.{ t --------------------Material-----------------------------•-•---------------- Se tic Tank: Not of compartments- well------------------ SDizeance from foundation Liquid depth--------------------------Capacity-------------------�- p Distance from nearest wel#-- — ----Distance from foundation.-_1�-_ --- . istan e to nearest lot line._��-- Disposal Fiel Number of lines_-_- -------ff_-.--L- --.Length of each line--.---'� - �---- id h of trench__..-- __ ------/--_-.------- Type of filter matarial_:1 f / __Depth of filter material..-.��--------Total length-----`—'--: Seepage Pit Distance to nearest well///-----.-. ....Distan'ce frcpm foundation---P -----------Distance to nearest lot line.lZ2----.---. N �� number of pits------- -------------Linin material--`1.-.-:_�- . Number g Size: Diameter-- 3_•�------.Depth---- . --'--------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material--------..-.--.----.----.---.-------- Liquid Capacity- ------------------- gals. Size: Diameter---------------------- ---------------Depth-------------- ---- ----- Privy: Lmr Distance from nearest well--------------_._.----------------.-------------Distance from nearest building---------------------------- ------ C.► ❑ Distancetonearest lot line----------- ---- -----------------------------•--------------------------------------------------------------------- V 1 1. ---------�� S �f1 �`---- / ------- --------------------- Remodeling and/or repairing (descri6e�:--. (.�' ---_- -------------------•-------•--------------------- -------------------- -1'------------------------------------------------------- -------------------- --------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County J ordinances, St d rules and regulations of the San Joaquin Local Health District. � p and/or Cantractorl{5i nedI----------------------- 7: ------------------------------------ By: A --------------- --- --- ---- ------------------------ - ---- Title • ................. (Plot plan, showing size of lot, locatio ('system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY Icy 14-1 APPLICATION ACCEPTED BY-..-------- f- --'------------------------------ ------------------------------------------- DATE------/ -- --" �f -----I/ REVIEWED BY---------------------------------------- -- ------- ------------- ------------------ ---------------------------------------- DATE-----------------------• --------------------------------- - - - ' BUILDING PERMIT ISSUED------------------ -------------------------------------------_--- ---------------------------------- DATE----- ------------------------------------------------------ Alteratio s and`or recom�le dations:--------------- -- -- --- -------------- - ---------------------------------------------•------------------------•-------•--•-----------------•---------- oz -".r/ a��• --------- -- ---- ------------------- ------ - ------ - ---------------------------------- Date....-- , .�---------------- ------ 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 G r.a.co.