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FOROFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -------- -------------------------------------------------- ------ ( p Duplicate) ____________________ This Permit Expires 1 Year From Date Issued Date Issued - - ome e to'.--� 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 LOCA ION/:�AVk_______.!i'w'._ __ � __-- _--a-. t_IlST i' / �rir✓t' f ��jjrr / f . 7 = f ` --- f.0- ------------------ Owner's Name - f) �t!t1 r �2'-��--� ------------0` - -------- --- ------------- Address ---------- r� Phone ' Address - 11 '------fL 14. f' �- ��----------- - ------------------------------------------------------------•----------------------•--- Contractor s Nam -•----- --° ------ --------•------ Phoney 4�./O_ ...-7----- e Installation will serve: Residence [N Apartment House El Commercial ❑# Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___l_ Number of bedrooms -___ Number of baths Z�Alof size ___ r f_ ____________________________ Water Supply: Public system ❑ Community system ❑ Private R Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-O Adobe❑ Hardpan IQ Previous Application Made: (If yes,date---- -- ---------) No E3" New Construction: Yes ❑�No ❑ FHA/VA: Yes P-' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� Septic�ank- Distance�6m nearest well_4,2_/,?_____ Distance from foundation__! ._ _-___.Material__7324t<= £_s__________________ No. of compjrtments----.,� ______-___size__ IO�Y_ ____Liquid depth__ �zf_"____-._ Capacity_-!-_Q_��__�'�. Disposa iField: Distance from nearest well.A!!! `9 .__Distance from foundafion. ;;Z0._.._._..Distance to nearest lot line-/- so Number of lines.--___---------._____._______Length of each line_ ".!!��_-�= _'.Width of french___czf'�____------.------------ Type of filter material__!-'�.r�_,`,e_-._-_Depth of filter Total ,length__--- --_`___________________ Seepag Pit: Distance to nearest welI,1VW_l..__Distance�fr�m foundation_/"-"i�__f_.Distance to nearest lot line__.fW_�__ Number of pits---___ ''_-_.___Lining material_ ?/!° %�CC'._.Size: Diameter__.�_-�'_.. ___._._.Depth_._- �_�______...___.._ Cesspool: Distance from nearest well__---------------Distance/from foundatio%'.�_.,----------..Lining material-------...____.___._____._________ ❑ — Size: Diameter------ -------------------------------Depth--------•--- ------Liquid Capacity- ------------- ---------gals. Privy: Distance from nearest wel!-----___--------------------------- ---Distance from nearest building____________________________..___.-_._. ❑ Distance to nearest fot line -- ---------- ------------------------ f----- --------------------------- - 1 °�" Remodeling and/or repairing (d scribe}:__-- _"'= l----------•---=---------------------------------------------------- -----•------------------------------- �r3 . . -----4-------------------------------------------�------------------------ - ------------------------------------------------ -- 1 1 1 I he76y certify that I have preparred this application and that the work will be donelin accordance with San Joaquin County ordinances, State laws, and rules anter:s�ulations of the San Joaquin Local -H-ealth District. ______ f .�s �... . c.� !/-5__ 1 �'-_------ Owner and/or Contractor (Signed) '.. r -_----------- -- ( ) B ��%fes 7j �L-- Title Y:-------------- --•-•---------•--- ------- -s -- { (Plot plan, showing size of lot, locati rl of system in reiation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- ------------------------------------------------- DATE-•-- I- _`. _ ------ ----------------- REVIEWEDBY-------------------------------------------- DATE------- ------------ - - ------- ---------------- BUILDING PERMIT ISSUED------------------- --------------- - DATE-------- ------------------ - ------ ---------------------- Alterations and/or rec mendations---------=--------------- ------------ v ----•------ • - ---- -- - . --------------------------- - I I FINAL INSPECTION BY: '�.. .. .. �sr .. Date.. � .- ._-(J ----------------------------- 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.0❑.