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FOR OFFICE USE: ------------------------------------------------ --------------------------------- APPLICATION:FOR SANITATION PERMIT Permit No. _Q ---------------- -------- - ----- --------------- -- (Complete in Duplicate) ._.________- -_ This Permit Expires I 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 compliancce�wiith County Ordinance No. 549. JOB ADDRESS A LOCATION 1�1QQx 1 ��1f � ----------- ------ Owner's Name L—`---=--------��2---Z ------ X ---------------------•----------------------- -------- ------------- - -------------- Phone------------------------------------- Address ----- ------ Address---------5-/'?l:` --- ------------ ----------------------•-------------------------------------------------------------------------------- ----------------------- ---------------------- Contractor's Name_S_ 11!7/V�------------------------ ---------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑. Other gT',ai ley. Number of livingunits: __ _____ Number of bedrooms _�. Number of baths Lot size -_- -d-- =-------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table'y ft. Character of soil to a depth of 3 fee+: Sand 9 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ " Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 001 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well _ r Distance from foundation_ _ _ r �'oIVe,�C� P - -- ------ - ��--------. Material---- -- ---------- ---- _-Li Liquid de th____�L Z__...._.Capacity No. of compartments Size 3 f� Q P. --•------------------ Disposal Field: Distance from nearest well--L _____Distance from foundation----AC�^-----Distance to nearest lot line___:�r. Number of lines----—-------------------___Length of each line____.t�__O_ pp _'__..Width of french.,-.2.1........---------------- l Type of filter material-- 6 C[ _.Depth of filter materia1--e-OZ- -------Total length_____/2_A_----_.______________ 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 well________________Distance from foundation------------ -----. Lining material---------------._____-----_-_________ ❑ Size: Diameter--------------------------- ---------=Depth------------------==------------- -- ---•---------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _____-------------------------------.------------Distance from nearest building-----------____-_-_.________.___.-__-..: ❑ Distance to nearest lot line----- --------- -------- --- ------------------------------------------------- ---------------------------------------------------------- Remodeling and/or repairing (describe)-------------- ------------ ---------------------------------I'--------------------------------------------. ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------=------=----- ------------------------------------------------------------------------------------- - t -------------------------------------------------------------------------------------------------------------------------"--------------------------------------------------------------------------------------- Y 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) --- '--------- ------------------------------------------I------ ------- --------------------------4-----------(Owner and/or Contractor) By ._ ld,(¢/l,t�.2sCJ� ---------------------- --------------------------------------------(Tif le)---------------------------------------- -- --------- ------ -- (Plot --- ---(Title)---------------------------------------- (Plot plan, showing size of lot, location of fern in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED -------------------- -------- -- ll ---- ------------------- DATE----- cam------ ------�---------- - REVIEWEDBY---------------------------------------------------------------------------- ------------------------------------------------ DATE BUILDINGPERMIT ISSUED------------------------------------- ---- --------------------------------------------------------- DATE------------------------------------ Alterations and/or recommendations:-----------------------------------------------------------------------------------------------------------------------•-------•------------------------------- ---------------------------------------- ----------- --------------------------------------------- --------------------------------------------------------------------------------------------------------•----------- ------ ----- - -------------------------------------------------------------------------------------------------------------------------------------------- ------------I---------------- --------------------------------------------------------------- ----------- ----------------------------- ----------------------------------------------------------------------------- ---- - ----- - -- ------------------ ---- - ---------------------------------------- ------------------- -------- T-�� r FINAL INSPECTION BY: .-- ---------------------------- Date--------------------- - ----------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornia Lodi, California Manteca,California Tracy,California r•.a.co.