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F 'R O�FHCE USE: � -------- ................... Permit Na. _..��• , y_ APPLICATION FQR' SANITATION PERMIT / --------------------------------------------'----- --'-- (Complete in Duplicate) Date Issued ------ ---------------- _--r . 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, Thisapplication is made in compliance w•th County Ordinance No. 549. (� �[ - bCvO„ 9 JOB ADDRESS AND LOCATION___ r_f s �.. i --nl _ ---- ------- Owner's Name------ Phone ,,i Address---------- -----------------------------------. -----=-----------•- -- ---------- Contractor's Name--------------- .`r ----+Phone_...... •--•----. ------------ Installation will serve: Residence Apartment.House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + Number of living units: _f-__ Number of.bedrooms S__- Number of baths.a-- Lot size Water Supply: Public system ❑ Community system ❑ Private [�epth to Water Table 14 ft'. Character of soil to a depth of 3 feet: Sand E] Gray..el`❑ - Sandy Loam _ Clay Lm❑. oaCla•y_❑..,IAdoba ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.---- ---I No 9?"e New Construction: Yes Ua- Vo ❑ FHA/VA: Yes P"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �'��` r} ' ` (No septic #ank or cesspool permitted if public sewer is:aailable within 200 feet.) '<. Septic Tank: Distance from nearest well_____ D____-DistanceJfrom foundation._. _______-M'ate�al_= ._ _.__ !/ .rfi No. of com artments__.._ -- {�-Size_t; G�-� t �----___Liquid depth----- / Capacity__ J Disposal Field: Distance from nearest wail.--_j�__._Distance from foundation_ LP__-------Distance to nearest lot line_________________ Len --- s // Number of lines--_----- gth of each line__�4_-___ Width of trench.--- -� A R, Type of filter material- .__/ ---G^ Depth of filter material____ ---Total length__�s, _ __________________-_ Seepage Pit: Distance'A6 nearest well______________________Distance from foundation___ ..___.Distance to nearest lot iine_____ _____. i Number of pits------2--__________Lining material-- _..Size: Diameter__,p.�"..___..Depth_._ _ .- -Cesspool:' ' Distance from nearest well_________________Distance from foundation--------------------Lining material___-______-.__-____-__-.----------- - . Size: Diameter ---------- Depth--------------------------------------------------Liquid Capacity---------------------------gals. YID ❑ tL (((1555 Privy: Distance from_n.earest well-------_..._._-.,_:__.----------------_,- Distance from•nearesf building-----------------------------------------. 1, F1 Distance to nearest lot • line------------•--------------------------------------------------------------JJ7 �"J� ----------------------------------'-'-----'----------- -------- and/or repairing (describe): ____________ ________________________________________________Remodeling o -- -----------• -----------•----••------------------------------------------------------ --------------------------•--------------------------•-----------------------------------------•----------------------•----•-------------•---------.._..------------------�-------------•---------=------ ------------- N1 . - ----------------------------------------••-------------------------- ------------------------------------------------------------------- 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 ict. of the San Joaquin Local Health Distr (Signed)--------•------- ---- - --------- ------ --- {Q r Contractor) By------------------------------------'-----------------•----------- -' - -- -- - _ ------------------------ - (Title)- ----------- (Plot plan, showing size of lot,.location of sysfe elation to wells, buildings, etc., can be placed on reverse/side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' < _-------------------------------------- DATE-------�---------- --` -------- REVIEWED BY--------- ----- DATE----------------------- n -- _------ BUILDING PERMIT ISSUED--------------------------------------------------------------� _ --- ----------- - DATE----- - ---------- -" ' _ , Alterations and/or recommendations:---- -1 .......... �`'`="t' �'-:'_ _ .`= _=G- ---- ----------- '.zh;��'_----:- -`•f"_�_�.-�. - - ------ ------------ -------------------=------------------------------------------------------------...------------•----- ----- ------ - ---------------------------------------- .-- .--------------------------------------'----- ---------------------------- ------------------------------------- --------------------- --- ------ - --- --_---1-------- -------------------- --------------- ----- - --- -- 'FINAL INSPECTION BY=—" 1.--------�----C-- x�.-�`_ .------ Date.---- -------'- -- - � --'-''-•1=:--;="---- ----------------------- ---- AN•.JOAQUIN LOCAL HEALTH DISTRICT r w� 1Got E.Haxeltan Ave. w T 300 West Oak Street s 124 Sycamore Street M 205 W,ilist 4th Street Stockton,California Lodi,California Manteca,California v Tracy;yCgalifornia ES 9 REVISED B-59 3M 3--53 F.P.CO.