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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __1......z..._�,. -------------- --------------------------------- JJ ---------------------------------- -----I---- ------ - (Complete in Duplicate) Date Issued .__ 7/! ___ -----------------------------._---------------------- 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 L CATION.------ 1-W {�-``✓E.--r---�-F "ix--- ---------- �z. � _ ! 6' !.7/�- lam._r!c ,L_jHone Owner's Name_________________________ ._ Address---------------------------------------------------- E", ,[?-------•----------------------------------------------------------------------------••------------------------------ Contractor's Name 14.ye-,F.L 5y. 1 c------ ---------------------------------------------------------------- Phone4GG.per`' ------ Instaliation will serve: Residence ❑ Apartment House ❑ Commercial �railer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms -------- Number of baths -------- Lot size ____ _ - E4cz-_____-____________ Water Supply: Public system [E�— Community system ❑ Private ❑ Depth to Water Table --..-___ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam �lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No [�r' New Construction: Yes [j—No ❑ FHA/VA: Yes ❑ No C3-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest --------Di4ante from foundation_ - ------------ __ __ p-Svc----------------- No. of compartments_._____ ____________Size �,F7(.lXW-4_- Liquid Ca acit read_----- Disposal Field: Distance from nearest well-----_--_-----._Distance from foundation---Zn�.---------Distance to nearest lot line__5�'__. Number of lines -----------------_____________.._Length of each line,/°__-__S _�_-Width of trench----A_g,��__________.-_ Type of filter material. ��° __-.__Depth of filter material./ ----4______-_Total length__,./,5; -------------------------- i Seepage Pit: Distance to nearest wall--------------------Distance fr m foundation/1;'_�___..-_.Distance to nearest lot line__r�W'..__ e [r7� p- -___-_-___Lining material.- Diameter_.-,r-=___��._-_-_ - p Number of its_-_-__ - �� _ Depth -- ------------------------ Cesspool: --- - --------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__._..__________....____..___________ ❑ Size: Diameter---- --------------------------------Depth----------------------------------------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.___..__'__.__..____._________------------ r ❑ Distance to nearest lot line---------------------------Y _---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------- ----�--------J`--- -----------------------•----------- ----------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ---------------------- ---------------------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. �. ____.._________________ w r and/or Contractor (Signed)----------------------------- / ) By �_�- (Title) r -- - ------------ - (Plat plan, showing size of l�ioaionystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------- DATE--- -- REVIEWEDBY------------------------- ----- -------- - - - ----------------------------------------------------------------------------- DATE-------------------•-------------------------------------- BUILDINGPERMIT ISSUED------------------ -------------------- ----------------------------------------------- ------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- ----------------------------------------------- ------------------------------------------------------------------------------------------- r FINAL INSPECTION BY: Date .:1 - ------ -------------------------------------- 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.CC.