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FOR OFFICE USE: _e yb P ( --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ZZl.`__F-°..... ----- ---- ---- --- --- ---------- --- --------- -- (Complete in Duplicate) ....__-------------- This Permit Ex fres 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 AND LOCATION ------------------- ------------------- ------------------------ �y; Owner's Name 1 L__ _rmzzr✓L! � F �l y ---- Phone------------------------------------ --------------------------------------------------------------- Addressll' ---'------------------------------------------------------------------------------------------------------------------------------- Contractor's Name----- ` {cICJ Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f__ ber of bedrooms N__ Number of baths �--- Lot size _,� 1� �_.1�_ .--------------- ---- -- Water Supply: Public system NNCommunity system ❑ Private IV Depth to Water Table ft. 9 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan p Previous Application Made: (If yes,date--------------------) No rpm New Construction: Yes Er""No ❑ FHA/VA: Yes B�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----------------- ._-_____._______..___.- ------- No, of compartments--------------------------Size-------------------------- -----Liquid depth---- ----------- ---- ----Capacity------------------ Disposai ./F'ield: Distance from nearest well------—-------Distance from foundation._..,!Q-----__.Distance to nearest lot line--- ___--- a r � Number of lines___________C______ Lengfh of-each line=_____ -h-------.."____.Width of trench.__,4_�_ Type of filter material__/_ W.W`�_Depth of filter material ________.Total length____Fa____ —15— - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______.______.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------- ---.- Cesspool: Disfance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.,-.----------------____________._____---- ❑ Distance to nearest lot line------------------------------------ --------------------------------- ---------------------------------------------------------------------- 10 Remodeling and/or repairing (describe):_______.- _ _ {� �11'.''r'�.��P' "-________ _____,:�e'..... ti ------------ x _------------------------------------------------------------------------------:------------------------------------------------------------------ ----------------------------- ------------------------- ------------------------------------------------------.--------------------------------------1-1------------------------------- ----------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County -J-I ordinances, State laws, and r les and'regulatio s of the San Joaquin Local Health District. (Signed)----------------- / '� - 1 -1-'-----------------•------------------(Owner--amd/,or Contractor) Tit ------------- (Plot plan, showing size of lot, location of system in relatio o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l� APPLICATION ACCEPTED BY-- ------------------------------------------------- DATEG7 --------------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----------------J--------- ------- ------- --- ----------------- ----------------- _DATE --- ----------------------------------------•---- Aiterations and/or recommendations �.c ..______ 3c� ' _�� ____ _ _S__�_ w------_---_-___ __-__ ja---------------------------------------------------------------------------------•----- ------ -----t - . ( --------------------------------------------- ------------------------------ ------- ----------------------------------------------------•-----------•--.----.---•-------------------•------------ -----•--•----------------- -------------------------------------------------------•--------...----------------------------------------------------------------------------------- ----------------------------- ---------------------------- ----------------------------------------- ---------------------------------------------------------------------------..--------------------•--------------------------------------------------------------------------------------- FINAL INSPECTION BY:..__.ka►.` �:�1" Date 9 2f ------------------------------------ SAN JOAQUIN LOCAL HEALTH.DISTRICT 1601 E.Hazelton Ave._- _ 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton;`Californio M T Lodi,California Manteca,California Tracy,California F.P.0 O.