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✓ FOR OFFId USE: i----------- —� APPLICATION FOR SANITATION PERMIT Permit No. .-�,1�Qal.-.. --------- ---------------- (Complete in Duplicate) Date Issued i This Permit Expires 1 Year From Date Issued f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. -A JOB ADDRESS AND LOCATION] -- --- -- -------'----- ------------- f a --- �— ------- Ph o e__ :_ f Owner's Name--------- �a----~---. 7 L�/ Address-------------------- :--------15-1------- ••------ --- -t59-.? Contractor's Name------•--- -- .��l .t -�•. -,/�-- ZllC�- --------------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ lMotel ❑ Other ❑ Number of living units: -- __-' ` � �.7�--------------------- 1lt Number of bedrooms -�__ Number of baths .+t.___ Lot size __. 1 Water Supply: Public system �ommunity system El Private ElDepth to Water Table -_.---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yf ,date....................) No [fl' New Construction: Yes E] No E]-FHA/VA: Yes E] No [� t TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .1 / Septic Tank: Distance from.1 nearest well__----_ _ _ -_ ---.-Distance from foundation------------- --. Materia.----_-_-____._-.-------__-_-_------------ p rtments--------------------------Size--------------------------------Liquid depth---------- ------ ---CapacitY----- ---�.�'.,. t Disposal field- Distance frominearest well...__ --Distance from foundation--------------------Distance to nearest lot line____-- . Number of lines_-..______.-/------- ------------Length of each line-__�-�--..----.------.Width of trench.-_. _ -��-----.--------- 00 -- ,. Type of filter material-----S/,r-14-4-Depth of filter material/_____________Total length___- __.__.___-___�.------- i l 1 Seepage Pit: Distance to nearest well------��=-Distance fro foundation _ .Distance to nearest lot line-- !A0.-.-.- �/ Size:-.Diameter _-fes ._-.Depth----�.��-�---------- L� Number of pi#s__________ _________Lining material-S'1jj�= W. i Cesspool: Distance from nearest well---------------- Distance from foundation------------ -__--.Lining material-------------------------------------- als. t ❑ ------ Liquid Capacity--------------------------- Size: Diameter ---- -------- -------=----- -Depth- - ------------ -------------- ---- --- g Privy: distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------- ..................... , � UX ^4- � � /�� ?.rte------------------------ !� Remodeling and/or repairing [delcribe):_......... ... .. J ----------------------•------------------------ ------ ------------------------------------------ ' certify that I have --_-.1 hereb----------- -- ------- --- ------I-- -- -- --=-------------- --•-- --- ------------------------------------------------------ ------------------------------------------- y y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la nd rand regulations of the San Joaquin Local Health District. (Signed)---------------------------4 /1/-.�= ------------------------------------------------------- ----- -owner d/or Contractor) -- --------------------------------------(Title) �. (Plot plan, showing sae of lot, location o sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -------------- ---- - APPLICATION ACCEPTED BY_..._ r4'-�---.----- DATE.--- ------------- - ---------- ------------------------------------------ REVIEWEDBY------------------------- ------ - - -------------------------------------------• DATE-------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------- ---------------------------------- --------------------- DATE.-- -� -----------------------------------•------- Alterations and/or recommendations: t� ---•- ��-r�-C�__�j j = ---------------------------------------------- -------------------------------------------- --------------------•------------------------------- ------------------ I ---------------__ . ...................................... t FINAL INSPECTION BY:.... .... . - -------------------- Date------- --- - -1..----�---S SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 S,Hoielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California -