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FOR OFFICE USE: — -- . � �•�- �. -- -------- ------------ --------------- APPLICATION FOR SANITATION PERMIT Permit No. .1.-r'-. ------- ----- ------- ------------- ----------- (Complete in Duplicate) This Permit Expires 1 Year from Date Issued Date Issued .-- r3p � i 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 c mpliarice with County Ordinance No. 549. Zp2 23p�Q3 9 E�CA,(_S . s I c f . . -JOB-ADDRESS AND E IONS__.--------�C -v��-E----------3�----------�-----_�-C1 P©RTS W�4 /",T A ----------------- Owner's Name------------ �IMM_1_..----•--� -- -�-��--Wh I Phone Address-------------- TIE ` ------�Q ------�y ,. C m�C_ .,- ---- Contractor's Name------!0Z7?)-P_�.._"--_- , ------"--------------------------------------------- --------- Phone-------•--- Installation will serve: Residence [J' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�____- Number of bedrooms___ Number of baths Z__ Lot size "_�Q ___ �� t -- --- Water Supply: Public system ❑ Community system ❑ Private eDepth to Water Table _;,5'-_ ft, Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe ❑ Hardpan ❑ � Previous Application Made: [if yes;f:'date---------- No Er New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND"SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I I - Septic Tank: Distance from nearest well-_-5. ___ Distance from foundation-__1. Material .D(�L/O©D LTJ No. of compartments------2-__.-____-__ depth_ - � __ Capacity.l '- "-- W i p /QlineS W Dis osal Field: Distance from nearest well-._. _ __.-Distance from foundation_______ _______ ___Distance to nearest lot __-- a r� ®� Number of lines- ---- --- --------��jj ---------Length of each line - --r?-_---Width of french------ r--------------- Type of filter material__�_____/12CKDepth of filter material___.. _____.__.Total length_-_.___--// _________________ I . -- Seepage Pit: Distance to nearest well_-------------------Distance from foundation___..________--___..Distance to nearest lot line------ t , ❑ Number of Pits Lining material --------Size: Diameter-------------_-- - ---Depth------ --------- Cesspool: Distance from nearest well_________________Distance from foundation ------------------ Lining material--------------------------_ - ❑ Size: Diameter-4---------------------- ---------Depth- ---------------------------------------.----------Liquid Capacity---------------------------.gals. Privy: Distance from "nearest well--------------------------------------------___-Distance from nearest building ' ❑ Distance to nearest lot lire-------------- -------------- --------------------------------------------- k . Fd Remodeling and/or repairing (ddescribe):----_"I-N1S----5X`'77AM-----©x_lip- r--------- ---•---------"-•-------•--------------•---------------------- ----------------------------------------------------------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------=------------------------------------------------------------------------------------------------------ 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 norContractor) By:--------- - ------- --------- --------------------- ------ - -(Title)_... (Plot plan, showing size of lot, location t of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -1i-,_C�.: -_ bATE.______' - - -_-_=65-- -- ----------------------------------------------------------- -- ---------------=----- REVIEWED BY ---- -- ----- ------------- DATE ------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------- --------- DATE ------------------------------------------------------ ----------Alterations ------------------ and/or recommendations:�_________________ ---------------------------------------------- ----------------------------------------------------------------------------- 1 ------------------- -------- --- ------------------------------------------------------ ------------------- ---- - ------------------------------------------- --------------------------------------------------- - D. •------ ------------------------------------------------------ -- I FINAL INSPECTION BY:. = Date---- -----_ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.I•lat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California \ F.P.CO.