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FOR OFFICE USE: )-KO03 S(4_ e+ ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. . :.f.7.....� ---- ----- -------- -------------------- ----- --- (CompleteNn Duplicate) Date Issued -_---------.--- __.___.-.-------.-----------.------.. I 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------------- - -- -----------� -�d_lEl l?t_ ?__ _ '-`'_G. l'-i - ----- - Owner's Name------�-) T4-�--------P�.---------•---kt-- f----------------------------- --------- ------ --------------------------------- -------------------------- Phone------------------------------------ Address-----------------------------4--62 ------ v_K1---------- ------------ 'X ( -------------------------------•-----•• Contractor's Name------ Q I5?. ------------------------ -------•--------•----------------- -------------------------------------------. Phone_---•------------------•----------• Installation will serve: Residence e!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __k_._ Number of bedrooms ---t... Number of baths----L__ Lot size _____ ___ _______________________.__-___._____-__._...-_.- Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 94 Hardpan ❑ Previous Application Made: (If yes,date---.--------------- ) No &' New Construction: Yes 5jr No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tl Septic Tank: Distance from nearest well_________________Distance from foundation__.__ _.____._.Material�et--- X35.�____...___ ✓_t7'Q No. of compartments-_.__._z--_____-____Size__7_X._Ga-_Y_.hio-_-__.___Liquid depth.........sS.._. L_-__ Capacity-•___l.�S__-_O- A .� Disposal Field: Distance from nearest well----- --._Distance from foundation----a C _-_-_.Distance to nearest lot line_________________ "a Number of lines._______________ (-------- ____--_• Length of each line__ ______--�_' Width of trench._-____— :/-----_--------------- nn �r----- Type of filter material _______Depth of filter material___ .__-_Total length---------t©_ ____________________ Seepage Pit: Distance to nearest well-----___--------------Distance from foundation....................Distance to nearest lot line__..___.__-_-_-.- s ❑ Number of pits_ __------------Lining material---------------------- Size: Diameter-----------------------Depth---------_____________________ d Cesspool: Distance from nearest well _________-__-_Distance from foundation--------- ------- ..Lining material_-___ _ _______---____.__. _ 2-1' ❑ Size: Diameter- -- --------- ----- -------- -------Depth-------------- --------------- ------------------Liquid-Ca pacify----•-------•------------••-gals. Privy: Distance from nearest well-----.-----------_-------_-----------------------Distance from nearest building.-_-___________--__._________._--..__-__ ❑ Distance to nearest lot line---------- --------------------------------•----------------•-•------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------- -------- ----------------------------------------------------------------- -----------•------------------------------••-------•--- -----------------•--••----------------------------------------•---------••----------------•-----------•----------------------------------•----••---------------------------------------------------------------------_ ----------------------- -----•------------------------•-------------------•------------------------------------------------------- -----------------------------------------------------•-----------------•--------------- 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. (Signed)------- -------- -- - ------------(Owner and/or Contractor) BY: S--C --- +�• --------- ----- - (Title) - - - (Plot plan, showing size of lot, locatio4wsystem in relation !.914 ells, buildings, etc., can be placed on reverse side). FOR D RTMENT USE ONLY APPLICATION ACCEPTED f` `-<.. DATE__ / -7 ---------------- -- -- `----- REVIEWEDBY---------------- , --`--- ....----------------------- - ------------------ ----------------------- -------- ----- DATE-----------------------..-.--------------------------- BUILDINGPERMIT ISS -- --------------------- ----------------------------------------------------------- DATE-------------------------------------------- --------------- Alterationsand/or recommendations------------------ --------- -------•--- ---------- ---------------------------------------------------------------...__....--------------------------------- ---------- • ----------- ----------------------------------------------------•------------------------------------------- ----- ------------------------------------------ - ---- ------ ------ ----- - ----------- --------------- ---------------------- -------------------------------- ----------- -- - - - / -- J1 L�— FINAL INSPECTIO `�-. ------------- Date...._----------------- - - ` ---------------------------- ----- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton 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 Press