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F R OFFICE USE: -------- -- -- -- �` J _ fIr APPLICATION FOR SANITATION PERMIT Permit No. _<. (...J--�.- -� �. � ---------------- 4 r � = (Complete in Duplicate) ' t P Date Issued=. _' --------------------------- --- This Permit Expires 1 Year From Date Issued /4 Application pis hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is,madeRm compliance wi .h Count Ofdin nae No. 549. ( .- - - ` �' JOB ADDRESS AND LOCATION `'! �= - -- ------- Owner's Name----- Jtt//al� �f•.C l ---------------- Address---I ! cJ' -1, c r•� �y --------------------- ------•-•---•-----------------------------------------------•-------•-----•------ F i Contractor's Name--------•-•---DL�!'r '^Y-----------•-----------------•----------------------- ------------------- ------ Phone.......-------•------_---------- Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-- --- Number of bedrooms ---2-N.- Number of bafihs ---- Lot size -_-_� �f_ _ - ----------------------- # Water Supply: Public system ❑ C ommunity system E] Private [B Depth to Water Table 64- ft. f" Character of soil to a depth of 3 feetSand Gravel ❑ Sandy Loam ❑ Clay-Loam.-D. Clay ❑ 'Adobe al--"Hardpan ❑ Vv it Previous Application Made: (If yes,date---------- -- ----I No Q�New Construction: Yes Lj�' IVO ❑ FHA/VA: Yes ❑ No [I}-1 ! I F 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.- - -_---Distance from foundation--_C-P--------- Material-_ +. _ - -------------- �g ,� ` i V' 0� No. of compartments-----------I I Size---`' f�� --Ligo'd depth------I�.f capacity t -- I IA(-----Distance to nearest lot line---h- - ---_- jr V1 Disposal Field: Distance from nearest welL�_,��../-._Distance from foundation-.---- Number of lines----I------- ----------Length of each line--------R2...-.-.-- --...Width of trench_---..-i ---------_------- + Type of finer material��..� _YCEC/ Depth of filter material----./�r- --_--Total length_------ - --------------_-_ 1 -Distance from foundation---_. ----____---- Distance to nearest lot line:---- ------ p i Seepage Pit: Distance to nearest well-----j_---_______-_-_ _ ❑ Number of pits----It-------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------- -----------------_t- 7 I` I w � Cesspool: Distance from nearest well------- ------Distance from foundation-------------------.Lining material_---------------------,----------- ) ❑ Size: Diameter-----I--------------I----------------Depth--------------------- -----------------------------Liquid Capacity--------------- ---------gals. I Privy: - Distance from nearest well.-------------------------------------------------Distance from nearest building- -------------------:---- -----� ❑ Distance to nearest lot line---------------------------------- ----- ------------------------------ ------------•------------- ----- --------------------------------- Remod 4in and/or re nng ascribe): y. _-%Z,s.h�42<---�------------------ �C�-'s�.�------------------------------------ ---;7 .C -ir '"...r�' # I _ --------- -------------------- --------------------- ------ ------------------------------------- ---------------------------------------------------------------------------------------------- -- I hereby certify.-that I have prepared thi application and that fh'e work will be done in accordarice with San Joaquin County ordinances, State w, and rules a regul ions of the San aaquin I Health District. . .. ----- - - ------------- ....(Owner and/or Contractor) (Signed)------ ---- ---•------- - ---- -- ---- ---- - ------- --- ------ - -------- - ' I t l -•--------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I i FOR DEPARTMENT UtE ONLY APPLICATION ACCEPTED BY--------- --------------- - -- ------ ------------- ------------------ DATE-- ------�----'�''=`�--- ------------ REVIEWEDBY------------------------------------- - --------------------- -------------------------------------------------------... DATE-------- --------------------------------- ----------------- BUILDING PERMIT ISSUED--------------- ----------------------- ------ =_ -------------------------------------- DATE------------------------------------------------------------- Alterations and or recommendations:---t.) ----LSA-.--:_____-. .r. ----------------- f .-. -------------------------------------------------------------- ------ ------------ Date-------` ^"1'- Vis" ------------- - - - FINAL INSPECTION BY-.................��.�-_---- -------- - ---------- ------ 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