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APPLICATION FOR SANITATION PERMIT Permit.blo. '04 r G7 b (Complete in Duplicate) Date Issued --------------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. ------------------------------- JOB ADDRESS AND . ,�LOCATION---------P'4. ---/_ ------.. - ---------- ------------------------•- Owner's Name------- q-� -� ------ ------- ------- ---------------._ Phone-- v ---fe--d Z Address -E}.2z �Yv ` -----� ---------•---•------------ Contractor's Name-------- �f Tf_ Phone.- �_.a.t__ - � --3----------,�f-,---- ------------------------•- ------- ---------------------------------------- �_ i'�2.7.E Installation will serve: Residence ga—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- ---- Number of bedrooms _ _ Number of baths __/____ Lot size ------- -------/_,Q t_?_____________________ Water Supply: Public system 2' Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2— Hardpan ❑ Previous Application Made: Yes ❑ No a New Construction: Yes Rq' 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 frominearest well-----------------Distance from foundation--------------------Materia4------------------------------------------------- ❑ No. of compartments-------. -----------Size-------------------------------Liquid depth-, ------Capacity------------------- Disposal Field: Distance from nearest well...1Yty_-,,_%._Distance from foundation___. v_f_____-Distance to nearest lot, line___$__�__-_--- Number of lines-------------------------- ------Length of each line-----.—.2_0---------------Width of french-_--.-�_4<�!---------------- Type of filter material__.X4_,G.4(------Depth of filter materiaL_1r -___.___-_.Total length----i�'�_�",---------------------- Seepage Pit: Distance to nearest,well---/_lY61-t_��°,'_`Distance from foundation F;_.Distance to nearest lot line---------____._- Number of pits----_./-____.._.___Lining maferial___Aoae�__.Size: Diameter__.- ��...... �� Depth = )" Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material_-----____.____.____._.____._______ f Size: Diameter---------------------------------------De th-------- ----Liquid Capacity ------------gals. Privy: Distance from{nearest well-------------------------------_--------'--------Distance from nearest building----------------- ._________..__.____.._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------- ttt Remodeling and/or repairing dcribe :__--___/_�1._,l' __. R es �/ z F._ , -`-�-----�--------------------- �;��---'`-------------------------------------------•-- --- ----------------------------------------------- - ------------------ { -----------------------------------------------------=------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County � d regulations of the San Joaquin Local Health District. e ! Si dce5, tate laws, an rules u a - ----/I = Owner and/or Contractor) By: -------------------------------------------------------------{Title}-- --------------------------------------------------------------- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). # -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- C �r �' ~T� " ------- ------ DATE----- � .1- i ------ DATE REVIEWED BY---------------------------------------------�----------------------------------------- - - BUILDINGPERMIT ISSUED----------- --------------------------------------------------------------------•-------------------- DATE Alterations and/or recommendations:-•-------- --------------------------------------------------------------------------------------------------------------------------------------•----------- ------------1 -� =------------------------- ---- ----- - -- -- ..:. ---- -------------------- ---------- ----------------------- ------------ f - ---- ---- --------------------�---- ----'� ---._...-.-------------------------------- ----------------- ------------------------------------- FINAL INSPECTION BY: -._ .-_./-_-7r1 `2 4 Date---------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ' 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised V59 F.P.Co. 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