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FjOROFFICE USE I � •. p APPLICATION FOR SANITATION PERMIT Permit No. .. .... .. ........... ------------------ -� =--------------------------------- -------- --------- (Complete in Duplicate) T -------------------------------------- ------------------ This Permit Expires. 1 Year From Date Issued 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. JOS ADDRESS ANDION-_ ip -_ -� � r' -..-�_f?---S,, �l6,�AOe7e------------------------------------ Owner's Name 4� 1Q'-------- --------------------- ------ - ------------------------ Phone-------------------- Address------- -.. . !�_. -_ a.-.T Contractor's Name-------�`+Fs� Com/ - ----------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ['Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .9- Number.of baths __Z__ Lot size ------------------------------ Water Supply: Public system ❑ Community system ❑ Private [eepth to Water Table,'oft 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 Gg/New Construction: Yes R20"qo ❑ FHA/VA: Yes Z�- '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-yl.e------.--.Material_-f�40� ' 10 %<y'" _ -- ---------- No. of compartments----- --------------Size.....67-__,WY___Uquid depth_-.- ..--.. Capacity-_t --_--.--- Disposal Field: Distance from near t well. - ----Distance from foundatior9___� �_--_Distance to neare t lot line_--------- Number of lines_ Length of each line- ft 4_P_ _4V Width of trent �� Type of filter material--->t ___Depth of filter material 's/_______Total length __/W- --------------------------- Seepage Pit: Distance to nearest well----- -----------_----Distance from foundation--------------------Distance to nearest lot line----------------- f ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth--------------------------------- 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___.__---.--.----------.----------..--.-. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----- - ./'- f-'�---�- �-° = ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------.....-•----------------------------------------------------------------------------------------------------------- -------------------------------- ------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rule regulations of the San Joaquin Local Health District. (Signed)---__--/z��------ --------- ---- (Owner and/or Contractor) By---------------------------- (Title} ��•.��---- ---------------- - (Plot plan, showing size of I ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__--_ - - ---.----- DATE-.- -� lam- ------------------------------------------------------- -------- ---------------------------------- REVIEWEDBY---- -------------------------- - ---------- -------------- --------------------------------------------- DATE--------------------------------------------------- - BUILDING PERMIT ISSUED --- � Z� - DATE '-Alterations and/or recommendations:----___ -15— ------- -_--._.----_-._-___---_.------_ ----------------------------- -------------- ------------------ ---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- -----------------------------------I --------------------------------------------------------------------- --------------------------------------------------------------------------------------- ------------ ------------ -------------------------- ---------- --------------------- - ------------------------------------------------------------------------------- -----------�------------------------------------------ FINAL INSPECTION .......:..... . :� - Date �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California . F.P.CO.