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FOR OFFICE USE: I----------- -------------- --------------------------- -- - --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. V lil 1) -- ----------------------------------------------- 3 � ; _ ------- ------- (Complete in Duplicate) ------{.--------- -------------------------- ` This Permit Expires Year From Date Issued 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. JOBADDRESS AND LO ATION------- -------- -------------------------------------------------------••------------ Owner's Name. _6.' • 11 ------- -------- T j9 ---- ---------- ------- ---- Phone----------------------------------- Address-----• yt.._�✓,,<1r� r: / Contractor's Name------- -----1¢ Phona_ �_. installation will serve: Residence ❑'Apartment House ❑ Commercial L] Trailer Court E] Motel ❑ Other El Number of living units: ---e"*-- Number of bedrooms _ 'Number of baths __/'.._ Lot size __._ _�-0K� .Ip e— ------------------- Water Supply: Public system E] Community system ElPrivate LODepth to Water Table -�,Oft. ' Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___________________J No [R- New Construction: Yes El No ['FHA/VA: Yes El No.[ � }� 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,-4>O___Distance from foundation:f _.-s--_.Material_-L-,e - _.. No. of compartments Size r ''r Liquid depth `� .�... CapacitY, Disposal Field: Distance from nearest well. -_4p Distance from foundatign__- ---Distance to nearest lot line_�F� �� Ay Number of lines_: - ----- --------------Length of each lin eh - trench. ------------------------ r Type of filter mate ial - ---DE th of filter material__ Tg ---.----Total len thK_ -- -- Seepage Pit: Distance to n earest well-___-----------------Distance from foundation--------------------Distance toJneaest lot line - -----•- ,.. aterial---_-�------------ --- Size: Diameter-------- }. - - ❑ Number of_pits--- - ------ ----Lining m __JCesspool: Distance from nearest well.- __:___._____Distancefrom�oundation- � ..!Lirtigm�enal_.a_- ------------------- S ___ SizeDiame ^ Depth Li uid Capacity gals. 0 — etr . Privy: Distance from nearest;well-------------------------------------------------Distance from nearest building--,__._____-_:_.________-.---.-____.___. ❑ Distance to nearest lot line---------------------------------- ---------------------------------------------------------------------- -------------- t eI Remode4ing and/or repairing {describe}:------ -L( ------ s - -- �t�x ------------------•---- -------- --------------------------------------- 't ------ ------- --------- - _4-:'_- f -------`---------------------------------------- -- - ---- -------- --- -- -- -- - -- -- ---------------------- ---------------- - - ---------------------- - -. -- ------ -----------�3 - - ---- ----------------- 1 hereby certify that I have prepared this application and that the work will be done accordance with San Joaquin County ordinances, State nd rules and regulations ophe n - oaquin Local Health District. St /�/,� / �--................ wn and/or Contractor) (Signed)) tv By: o -------------------------(Title)---- -- --s--- --------- .. -- --•--- - ------------------ ------------------ (Plot plan, showin?size f lot, locati n �of system in relation to wells, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ----------------- ---------------------- --------------------------------------------------- DATE-- ------- ---- REVIEWEDBY-------------------------------- ---- -- -------------------------------------=---------------------------•-•- DATE-- J ._. BUILDING PERMIT ISSUED----------------------- - --------------------------------- DATE Alterations and/or recommendations:---------------------... ------------- -----------------------------------------------------------------------•-------------- t -----------------------------------------•--------•---------------------•------------------------- ------------------- ----- -------------------------- ----------------------------------------- -------- -------- -- --- -- --- --- ----------------------------- I -------------------- -------------------------- -------------- -------------------------------- ---- -- - - - ----------°---- --- ---- ------- p rDate----------------- -- ----- FINAL INSPECTION BY:----- ------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT k Sycamore Street 205 West 9th Street 524 tGol E.Hazelton Ave. l 300 West Oak Street- 1 Y Stockton,California I Lodi, California Manteca,California Tracy,California ' IF.F,C a.