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FOR OFFICE USE: -------------------------------......... '.--.--.--.'..............._. - - APPLICATION FOR SANITATION PERMIT Permit No. .. .�_ ._J}. -- -------------- -------------------------------------- (Complete in Duplicate) ----------------------------------------------------- --- This Permit Ex fres 1 Year From Date Issued Date Issued ......1 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----------_ ----__.le_.__. C Off! l ko.Q.....414 v'� 14--L--- ti------/".4�� .vv_---------------------- =------------------- ---`�- Owner's Name.__________`_-_.______ �'� - -------- - -------- Phone-----------------------•- - Address-----. -----•-----•-•-•---------- -------•--------------------------------------------------•-----------------...__.. Contracto`r's NameCJS(V�-�-----•------------------------•---••-•-----------------------------------------------••--•-------------------- Phone----------------------------------- Installation will serve: Residence 2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms __Z___ Number of Baths __ -__ Lot size _._____._`3 - Ae_2-�'' --------------------------------------- Water Supply: Public system ❑ Community system ❑ Private ® -Depth to Water Table 4�(?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------:__._._I No X New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ®' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_°-�Qv__.__Distance from foundati . _O Materia------ .__ ---------- 19 i uid de th____.___-_ftl__._ No. of compartments---------- ------ Size------_f -- _ __ q p _.----_Capacity_.1o_Q_.�_t disposal Field: Distance from nearest well.,�_`._Disfance from foundation------- 'V`__-.Distance to nearest lot line___- D4 Number of lines--------_-�-------------------Length of each line---------- --------.Width of trench--------sP ------ Type of filter materiaU2R&m-91�KDepth of filter mai-eriaL____«________Total length___.___e_ice __._____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--- c'`_ r ❑ Number of pits----------------------Lining material-_--_------------- ----Size: Diameter.-----------.---- ----Depth--------------------------------- Cesspool: DiOdnce from nearest well-----------------Distance from foundation--------------------Lining material-...___._.____-----___..__-________- ' ❑ Size: Diameter--------------------------- ----------Depth--------------------------------------------------..Liquid Capacity----------------------------gals. fi Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------_----. ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------------------------------------- ------------- Remodeling and/or repairing {describe) -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 regulations of the San Joaquin Local Health District. (Signed) � ------------------------------------------------ -- Owner and/or Contractor l [ By=-------- ----------Fillvw ( ) �- - , s ---------------------- Title ----------- - -- -- ---- (Plot plan, showing size of lot, tom in relation to wells, buildings, etc., can be placed on reverse side]. a -- - FOR-DEPARTMENT USE ONLY } + :. Cf—�G�+ APPLICATION ACCEPTED BY -------- DATE---------- // ------------------ REVIEWEDBY---------------------------- ==� ==_ ' = -`_---------------------------------------------------._ DATE------------------ ------------- -------------------------- BUILDING PERMIT ISSUED r ------------------ ---------------- DATE--- ---- Alterations and/or recommendations:_____ .. ------------ cn..c® - - - - --------- - � F - - ,W_ ...: - -- ---------f�0-��----� � / -------- ---------- - z - ------------------------------------------------------ .Q --- - - -- - - ------------ ----- - - FINAL INSPECTION ----.a�_ - Date-------- 1- - ----------------------- - - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5teckton,California Lodi,California - o Manteca,California Tracy,California f•.P.0 R.