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FOR OFFICFS-USE: . ----------------------------------------------------- �— �j' APPLICATION FOR SANITATION PERMIT Permit No. �!ti_-_Gcy!__ -----------:--------------------------- ---- ----------- (Complete in Duplicate) ------------------------------------ "'-- - --- This Permit Expires 1 Year Fro n-Date Issued Date Issued ---;.7---------- r_L2 Application is hereby made to the San Joaquin Local Health District,for a permit to construct and install the work here' described. ; This application is made 'n-�compliance with County Ordinance No. 549. Tc ? JOB ADDRESS AND LOCATIONI---Aj—, 1 ----/Ol,lIS- - ------------------- ---- I_� T , Owner's Name--------- -- -- - - --- - --�-�0��_�'-�1qA------------- Phone----- -Z�-�--��-�--t-�-- Address 3 -- ---: Contractor's Name__C11fk&1.-F—.--------------•------------------- - ----------------- Phone----------------------:---------- Installation --•---- -Installation will serve: Residence 111�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ L Number of living units: __j____ Number of bedrooms 3-_ Number of baths _f___ Lot sizeAcojFacav-- Wafer Supply: Public system ❑ Community system ❑ PrivateAT-1"Depth to Water Table -:/- ft. Character of soil to a depth of 3 feet: Sand- '',©Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes„dafe ) No /New Construction: Yes E] No HA/VA: Yes E] No TYPE OF INSTALLATIOWA D SPECIFICATIONS: (No septic tank or cesspoolapermitted,if�publi.c.sewer is available within 200 feet.) - I Septic Tank: Distance from nearest well___50---6stance from foundation-----/0____.".M t�ria{... �al�--------.-. No. of co`mpartments_ ._ ._." � ___._�Size_ .. _ _ _,��__Liquid depth__-- -------Capacity__. fi� -___. Disposal Field: Distance fromnee resf�well'_ ..!Distance from foundation_____10".__....Distance to nearest lot line______ � _ Number of lines------------- -----------------#_Length of each line---------- ..........Width of french_______ .___. Type of filter material....Pocl<<Depth of filter mater�al-----1 ------------Total length________________7�5�_---------------- --^ Seepage Pit: Distance to nearest well!_____________________Distance from foundation___-______________.Distance to nearest lot line_-__--_.---_---.- ❑ Number of pits-------------- ------ Lining material_-_--.---_----._.Size: Diameter----------------------.Depth-...-._--- .----------- ----------- Cesspool: Distance from nearest we!#_________________Dist dnce from foundation -------------....Lining material--------._.-____.....__..__.._______ ❑ Size: Diameter----------------�----------- ---------Deptx a -----------------------Liquid Capacity----------------------------gals.3 Privy: Dista le from nearest yell_____".-. ---- ------------Distance from nearest building------------------------------------------ 1 ❑ i Distance to nearest lot line------------------------- ------------------ ----------------------------------------------------------------------------------------------- I Remodeling and/or repaihng-(describe),:---= - ---- �--------------•--------------------------------------- --------------------------------------------------------� II ! --- ------------- -------i..---••-----------------•------------------------------------------------------------ ------------------------------------------------ ----- --------------------------------- I f ' I hereby!certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St. to laws, and rules and regulations of the San Joaquin Local Health District. (Signed) --- - = -y - ----------- -----------------------------------------(Owner and/or Contractor) ----------------------------------------- ----- -------- ----- ---- --------- ---- ---------- Title -------------------------------------------- -- - --------- ---- ; sY (Title) (Plot plan, showing size of lot,locafion'of system i rn e'lafion{o ells,buifdings,}efc., can be plac£if on reverse side). FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY----. -------------------------- -- ' - �� -- ----------------------- -- -- - -- DATE-- - - -'"-f'f-�----.`_F�...�-- - REVIEWEDBY--------------------------------------------- --------------------•-------------- ---------------------------------- DATE--.-.------------------- ----------------------------------- BUILDING PERMIT ISSUED------------- ------------ DATE 1 Alterations and/or recommendations:------------------------------- --------- ---- ------------------------------------------------------------------------------------------------------------- F ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ .. _______________________________________________________________________________________________________.-----_-_.---.-______.._________.______-____-_____.._______________.___..__-__._________-_.-________-___-________.._ ... ^ ______________________________ _ _________________________________________________ ..............__.-________...._..._._._....-..__ �.__-._ _ -------------- __ _- ---- --- ---------------------------------------.- ---.---__...._-_____.-...--__.._______._._____.--__.____..__-_._.____._.______ VIM FINAL INSPECT-IBN—B -- ----- Date-- f l T 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 F.P.CO.