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............................................ ........................................................ APPLICATION FOR SANITATION PERMIT Permit No. .fQ .....----•............................------.......... (Complete-in Duplicate) Date Issued . . ..................................................----- This Permit Expires 1 Year from Date Issued � r aB/ 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 LO ATION.{�I�.--J-.?6...._.a---...f /,:/ ?Wis_� L .+.__ j�'�l��. .__.� Owner's Name.........(217-9?-6......_... i:'_ tC -----------------------_-•----•-----__------------ P one..................................... Addressa --••-------------•• -----------------••--•---------------------------------------------- .-___---------__.._.... ---•-----------•-•---••-•---------- - Contractor's Name (fhi' j7- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:Z.._ Number of bedroomsS�.... Number of baths,2.. Lot size ......'__.............-....... Water Supply: Public system ❑ Community system ❑ Private @?'Bepth to Water Table/.1-ft Character of soil to a depth of 3 feet- Sand❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay Adobe❑ Hardpan❑ Previous Application Made: (If yes,date...................) No New Construction: Yes A-"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 Tank: Distance from nearest well__._._ . Distance from foundation...Z .._ Mat�i�l ---------------- 21- No. of compartments-.�n..................Size, tYy.._ .! l2 Liquid depth-.��4--.-.........Capacity, Disposal Field: Distance from nearest well. '.....Distance from foundataon__..fa_._.....Distance to nearest lot line..._-_._.... Number of lines._.s.�..... ength of each Iine*'.O _ Width of trench��,/A Type of filter material�! IQ - Depth of filter mate rial._.�s _._._....Total length.._ .7C-Cl-._____._________._..._ Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line................. ❑ Number of pits...................Lining material......................Size: Diameter.......................Depth................................. ` Cesspool: Distance from nearest well..------------Distance from foundation...................Lining material..................................... ❑ Size: Diameter.-- -----•---.....---------------Depth........................- .....................Liquid Capacity............................gals. 1 Privy: Distance from nearest well......................._........................Distance from nearest building.......................................... ❑ Distance to nearest lot line....................................--------------•- - -- �1 _.et '� Remodeling and/or repairing (describe):----- - __ ------ - ----- ----_........._-----••-_-•---._.-----------............ --------------------------------------------------•------------------...-----------------------------------------------------------------------------------------------------------------•---•--------•------- ------•-------------•------------------•-••------------------------------------------------------------------....................................................................-................................ . ------•----------------'...................--..................................-................................- --- ------_...........•-•---......--..................... --.--.-- ...--- ..... I hereby certify that I have prepared this applicafion 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 .... ��i!if..' .. .......... - r Contractor By:--------------------------------------- `-........I............-.................(Title). % E.M............... (Plot plan,showing size of lot,loc n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ....... - - DATE----•F�/-_._/..Z.a --------- , REVIEWEDBY...............................(. - ........................................................ DATE..................-...........................-......... BUILDINGPERMIT ISSUED------..•..................•--...........................-...................................... DATE------------------------------------------------------------ Alterations and/or recommendations:.......................---------_._..-..._....••--------------.............------------------••-•-------•--------••-••--•-------------------•------------ ...................•-•-•----------------------------.....-----•-•---------------._.------------------......_.------------------•---------------._...........-•-•------._...._.....---••--------•-----------........_..._. --•-•-......_------------------------•---------------------------------.....................------......--------------------•-----•---------------•------•----------------------------...........-----------•- ....................................-------.._..•--••-------.--.._._.......------................................................................-............-................................................ ................................................................................----.....--------------------._.......-•-•--------------------._......-•---------........./.._......----------................-------•-•-- FINAL INSPECTION BY:..... 4---<-------- ---- -/ti/ Date----•-......---�_-✓- ..................... 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 E.H.92M 1.67 Vanguard Press