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FOR OFFICE USEi"' - � �------------------- -------- �� - -�_.___.___._.- _�-�- APPLICATION FOR SANITATION PERMIT Permit No. ------- ------------------ --- ------------------- (Complete in Duplicate) ` ---------------- ------ -------- ----= Date Issued -----f -Z ------ ------- 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. od 7- ( YO—C92 I JOB ADDRESS AND LOCATIO ---- -----_ .- Owner's Name---------- :�.1.__ �}� ------- +--------fes _ -- - ------ Phone- 1"10--- "--- ---------(-Of-------e -- ------ ------*---- Address----------------t7l40 '� t : Contractor's Name-------.___ ' Phone.._7.1P _._.. _,F-V Installation will serve: Residence Apartment ouse [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms l-5___- Number of baths Lot size --------4 ------------------- ---- 1N7ater Supply: Public system ❑ Community system ❑ Private [4,-Depth to Water Table -------- ft. .-'Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Mader (If yes,date--------- __ -_ ) No New Construction: Yes No I ❑ � ❑ FHA/VA: Yes ❑ No © i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or,cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance-frbm nearest well------810----Distance fromNo. of compartments_.___ .�-----------.Size------ _-- �'��-�---Liquid depth-----tit- ----- ----- Capacity----•f-'�-[s �- Disposal eld: Distance from nearest well.._._ Q _Distance from foundation__/5~_ ----Distance to nearest lot line____ '+ Number of lines..-- #______, '_°G_ __..Width of trench--__-�_•-/___________________ __::____._. __-Length of each line__________,_- ` Type of filter material___+�rC.e•tr � Depth of filter material___.__ 'i`_-_Tota! len th_--.____• '� g ,,.. Seepage Pit: Distance to nearest 1�_� Distance from foundation-------------------.Distance to nearest lot line__.--___________ ❑ Numbdr of pits------------------ ---Lining material-----. ----.--------.-- Size: Diameter--------------_.........Dep#h--------------------------------- Cesspool: Dist nce frorn � - - - - --------------------------------.---._.Lining material------------------------------------- Size: S } ❑ Diameter nearest well_________________Desot}hce f------foundation Liquid Capacity_..------------------ -------gals . k Privy„ Distance from nearest well ________:_'__._-__:_r-__ Distance from nearest building ❑ __----_p j Distance to nearest lot line-_--- `s r -,_-r - ------------- ----- ---------- --- _. Remodeling and/or repairing fdescribe)_---_--------_----- ------------------ =------------------------------------------------ --------- ----------------------------------------• ---------- -----------------•--------••------------------- 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, State laws, and rules and regulati of the San Jo ocal Health District. (Signed)=------ ' -- ...... "-- -� --- -- ----- ---- .___(Owner and/or Contractor) By=---------------------------------------------------- - - -- ----- ----- ---- -- (Title}. - ---- ot plan, sowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY------------- _ _-----f_________---- -------------- DATE- - --------- D ------- - �- REVIEWED BY k --- ----------------------------------------------- --- DATE l BUILDING PERMIT .ISSUED ---------- ---------------------------------- ----------------`= DATE. Alterations and or recommen ations:._ _ A � _� � L c9(( t� ` - ---------------- -� -------------- �_. ..-� - -rt'� �� ` - - �� ` =.cam yam"�r['e_�� ccs.�r ��/C -� ,.�-�;.�.�C r � c = -a t c :=Y �- - _ -•/Y-E'- Q•��=---__ -irk -.'�--T -•- �•-----c-----•------------- s 1Z. -�-t . .�C�E' - —��r�[�t��""-- /� ------------ -=r--- ------`- -r'------ - `--�.. -h--------------------- FINAL INSPECTION BY:------ _-� GZ '�` d6V 'r'' Date_. �.. ------------------------------------ SAN - _.__...0...... ..............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. _% F