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FOR OFFICE USE: 5 ------------------------ -----------------I ----------- 1 ------------------------------------------------ ---- ---- APPLICATION FOR SANITATION PERMIT Permit No. .,�. 1.-.3.. . --------------" ..--_.----------- . .•rur.-_ =-, , _ (Complete in Duplicate) . Date Issued � A F_ r This Permit Ex fires 1 Year From Date Issued 2 0 —3&C --t 2— 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---•---R ------------Y1j1E - ------= Owner's Name-------I------ K ` C�-fel-T _t �- --- Phone._.-•---------------•---------•--•-- Address_-.........X77 j-- Contractor's Name__1141!tlt 1 ------------------•-•----•--------------------------------------------- ---•-•-----------------------------•----- Phone------------------------------------ Installation will serve: Residence ff]�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f_'Number of bedrooms____ Number of baths =_ Lot size ____ UD____e__1 a___________________- Water Supply: Public system ❑ Community system ❑ Private (�epth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑j Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: If es,dote------------------- 1 No New Construction: Yes �^ PP ( Y 0 �No ❑ FHA/VA: Yes ❑ No Q � L---T-YPE=OF-INSTAL•L-ATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--5v------Distan _e from foundation- 0-__.-______-Material__CQ(�Ch FTa ©� No. of compartr`rents------- _._ Size. / _IaX_ -----Liquid depth._.___-..--------Capacity/� -_ Disposal Field: efronearest well._.--p ---- Distance from foundation �- _ -----Distance to nearest lot'Ig El Numneof lines,: - ---- ----------- ----Lengthof each line------� �--- ---- --Width of trench--------- Type of filter mafierial-- r.e � Depth of filter material_____?....._-----Total length___________________I ________________._ Seepage Pit: Distance to nearest well_____.--______________Distance from foundation----------_---------Distance to nearest lot line--.__..._____._ I ❑ Number of pits_-------------------Lining material----------------------- Size: Diameter---------------------- Depth-----------------_--------------- Cesspool: Distance from nearest well_________________Distance from foundation-----_------------".Lining material_...---------_.____._______________- �o ❑ Size: Diameter.-!----------------------------------Depth--------------------- ---------------------------._Liquid Capacity--------------------------•-gals, i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------4-.P ❑ Distance to nearest lot line------------------------------------------------------------------------------=----=•--------------------------------------------------------- 1 Remodelingand/or repairing fdescribe)-----------7-------------- ------- -- --------------------------------------------------------•------- ------------------------------------------------•- = -------------------------------------- ------- - - ---------------------------------------I------------------- ------------------=------- ---------------------------------------------------------------------------------------------------------- 3 r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 3 � ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---- (Signed} ------�:.�-�------------------------------------------- ---- ------------- - ------ ------- ---------- (Owner and/or Contractor) _. - - - -- . — — _ By:--------- ---- - ------- - �----- ------------------------------------------------------------------(Title)---------------------- --------- ------ .._..------------------. (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----TIF3,0- -------------- -- DATE- �� REVIEWEDBY--------------------------------- ----------- -------------------- - --- ----- ------- ---------------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------- -----------------------------------------------------------------._ DATE-- -------------------------- ---------------------------- -- Alterations and/or recommendations:-------------------------- --------- - ---- - -- ---------------- ----------------------------•-•------------•------------------------------------•--------- --- ----------------------------------------------------------------------:------- ---------------------------------------------------------------•------------------ -----------------=----------------------••---------- --------------------------------------------------�� ---------•---._.....----------------------------------------------------------------------------- ----------------------=------------------------------- --------- ------------------------------ ----------------------------------------------------- ---- / 4 FINAL INSPECTION--BY-: . � - - � U Date------------ --------------- ----5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P•CO.