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C FOR OFFICE USE: 3,9 ..-rJ-ly-----"- -----_ - ------ APPLICATION FOR SANITATION PERMIT Permit No. .......:...........'_.-. (Complete-in Duplicate) -_-�.. . Date Issued __ This Permit Expires 1 Year From Date Issue 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. Aj JOB ADDRESS AND CATION-----1-------- �/�✓.- C/ ------ - ------ ---- r Owners Name___ __ -•-- ------- - --- ---- ------------- Phone4o,_,:____-----�'$ I f ----_ Address-.....--------- ---� -- ?� S I ---------- ------ one_. _ t Contractor's Name------ ------ --- -- ------ ---- -- - ---------- ----------- h r Apartment Houser Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Resi ence � p ❑ Number of living units: __[..__- Number of bedrooms _�-t_. Number of baths J____ Lot size _-- -5- - -- - 5------------------------- I. Water Supply: Public system ❑ Community system 0 Private ❑ Depth to Water Tables_5_ ft Character of soil to a depth of 3 feet• Sand El6 a el F1 Sandy Loam El Clay Loam [] Clay ❑ Adobe, Hardpan ❑ Previous Application Made. (If yes,date_- 1 No .New Construction: Yes ❑ No —FHA/VA: Yes ❑ Nb� HIt ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________D stance`fr6m foundation__.___.___.--____.Material ---------..___.__.___._-.__.______.___..--.___.. r` � ` - `- Liquid depth-- ------ - --------Capacity ❑(�x[�-� No. of compar#ments--------------•---------._Siz�,yye-----•----"_---•-=- - - r ---------------�---- .ryt -' , J . -y Disposal Field: Distance from nearest weiI.Aj6r.#C_._Distance from foundation___Z5.___-_....Distance to nearest lot line_ Number of lines---A---- t_U) -------Length of each line-.-.__�-'- _,,f------Width of trench... [--------------------- Type of filter material.C.- _.---Depth of,filter.material-_. ' Total ken th___.�.-�___________________________._ �- - g _ Seepage Pit: Distance to nearest welLl.Q-0/1Q',__ Distance om %°undation___-____.___.Dist r�ce to nearest rat line_. Lining material._ ___ _- k ,--_. $ize: Diameter.- ------ p Number of pits. ----De th-- —----------------- ______________Distance from foundafiion._...- _.____. -_ Lining material__._____.__.___....._.___-------- ---- Cesspool: Distance from nearest well _ ❑ Size: Diameter- -- ----"- ----- ----- ----------Depth----- ---------- ------- -- ----------- Liquid Capacity gals. t Privy: ; ---------Distance from nearest building---------------------------------- ------- Distance from nearest well_________________________.... - ---------------------------------------------------- Distance to nearest lot line----------------------- - -------------------------- -- - -----'----- - ` �.... 1 e IF t - ------ Remodeling and/or repairing (describe):___--- ---'-- -- ---. - .---� --- ------------------------ ---------- -------- t �--------------------- ' r�c'�``r``v --------- -------------------- f' -------------- ` - `�---------------- �------- -------------------------------------------------------------------------------------------------------------------- E -- - -- ------------------ ---------------------- ---------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I h epared this a-PPlication and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules d regulatio of the an Joaquin cal Health District. f (Signed)_ __...(Owner and/or Contractorl - -- - ----- -� -- - -- - ------- -----------• ------------ ------ -- ' ---------------------- -- ,�, � � ` ' _ lti� `'"` (Title . (Plot plan, showing size of lot, location of s stem in relation to wel s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -' - ---------- DATE-----/07 22--0 . .._ BY------ ------------------------- - ----------- --------------- ----- DATE --------------------------- REVIEWED BUILDING PERMIT ISSUED-------- -------- - ----- DATE- --- ---- ----- i 4 Alterations and/or recommendations:-----------_--- - ------ ------ -- -- -------------...... ----- ....... ----------------------------------------•------------••-------• --------- I --------- --- --------------------------------------------- --------------------------- ----------------------- --------------------------------------- ------------------------ - -------- , --------------------------------,---------- - i------------ ------ - o- ----- - --- .............. --------- ----------------------- -----I------------------ -- FINALINSPECTION BY:..-.._._.___.:'.`.. .......-----_------------------ ----------- Date.....--------------------------- ------------------------------------- " ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Pressrti. 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