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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __V-_1�._��..� ----------------------------------------------- -- (Complete in Duplicate) /� '--._-. This Permit Expires 1 Year From Date Issued Date Issued ._f_�- __To� 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. O2,p__ p/ JOB ADDRESS AND - Owner's Name ,j��' �C!Y�1-- -------------------------- ------------ --------------------------- -------- ------- Phone----•--------------•-••------------ Address �------/------------------------------------------------------------------------..................................... Contractor's Name.--------�0.r� --------=---=----------- --------------------------------------- ------ Phone----.._-----------------_------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ;u Number of living units: _f __ Number of bedrooms _ ._ Number of baths _ _ Lot size 421--- -- ---.----______________-_--__-_--_----___ i Water Supply: Public system E] Community system ❑ Private Depth to Water Table j99Qft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [I Adobe E] Hardpan Previous Application Made:: [If yes,date-----------.------..} No [n New Construction: Yes ❑ No 2�` FHA/VA: Yes ❑ No Pq-- 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-__--..___-----Distance from foundation--------------------Material---_--------------------------------------------- No. ____ -__--------_-.-------._____.__.No. of compartments--------------------------Size------------------------ ._Liquid depth--------------------------Capacity----------------------- i Disposal Field: Distance from nearest well.�� Distance from foundation_-aA0---------Distance to nearest lot line--_`"_____- �? �®f Number'of lines-------/'------- - --- -3_-_-- - ` ength of each fine______.._--_ Width of trench_v ._____ WI (� Type offilter materialZ.2/., epth of filter material____`�-�f_Total length_ -F_ __________________________ O I q de Seepage Pit: Distance to nearest welf--- ��_____Distance from foundation__� -------.Distance to nearest lot line...—___-__. Number,of pits----�_-------------Lining materiaSize: Diameter___;?3'*--------- Depth.P.-4.4_.!�------------------ Cesspool: Distance from nearest well--------------__Distance from foundation___-----------------Lining material----------------------------------- El Size: Diameter----------------- --- ------- - -- Depth------------------------------------------- --------Liquid Capacity----------------------------gal. Privy: Distance from-nearest well _-___..___-------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line--- - --------� -- ---------------------------------------------------------------------- II 17 Remodeling and/or repairing (describe}:----------- -------------- -----------------------------------------------------------•i -----------•------------------------------------------------------------------------------------------------------•------------------•----------------------------------------------------------------------------------- -- x ��i P,: " ---------------------------------------------•------------------------------------------------------------ -------- ------------------------------------------------ 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, and rules and regulations of the San Joaquin Local Health District. -------------------- o1&0__7----- 1�� ----------------- --- .---------------- Contractor (Signed)------ ----- - - -- -- -- --- -- �- --- - - - -. ---------------( ter r �" By:------------------ ; ------------ � �� `--------- -----(Title] .. ...----------_.... J I 6 ----------------------------------------- ------ --- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). n FOR DEPARTMENT USE ONLY „ Q „ APPLICATION ACCEPTED ` --- ------------------ ---------------------------------------- DATE-.-- -O - T REVIEWEDBY--------------------------------------------- ----------------------- ------ - ---------------------------------------------- DATE------------------------- "t BUILDINGPERMIT ISSUED----------------------------------------- ----------------------------------------------------------• DATE------------------------------ --------------- ------------- Alterationsand/or recommendations:----------------- -------------------- ------ --------------------------------------------------------------------- ------------------------------------ ---------------------------------------- -- ------------------------------------------------------------------ ------- --------------------------------------------------------------------------------- ` ----------- ----- -- ----- - ---------------------- ------------------------------------------------------- ----------- ---------- ----- -------------------------------------- -------- FINAL INSPECTION BY-. ren_ . - -- --------------------- Date/ G - ------ ------------------------------------------------- •t. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave.'' 300 West Oak Street 124 Sycamore Street 205 West 9th Street �II Lodi,California Manteca,California Tracy,California {; Stockton,California JL F.P-CG.