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FOR OFFICE USE: . ----------------- - APPLICATION FOI' .:SANITATION PERMIT Permit No. .�./...��U. ------- - ------------•------------------------- (Complei -,in Duplicate) I �. Date Issued .-- Q-- -.-..------------------_.--...-.---..-.-.-............--- ['This permit Ex ires i"Year From 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. JOB ADDRESS AND LOCATION--- *-----/y�- ------- �� --------------------------------------•------------------------------------ ------------ f k Owner's Name----------------I -�f �.Iyf-v=. ,,— _ _ _ T—=-- __ - PhoneTl`- •--.----------.6-�. "'Address---------------------- ------ .._..-. �_/...+!'_1.?�t� /---••--------•--- •---•-- Contractor's Name---------------'9 ✓ l----------------------------------------------------------------------------------------------------------- Phone..--------------.- -.._-.---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: J-_-- Number of bedrooms __ - Number of baths _-�____ I of size ---5�- -_- -_----.-.- Water Supply: Public system 16 Community'system ❑ Private ❑ Depth to Water Table .s ft. ; Character of sail to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Claygg] Adabe Hardpan ❑ Previous Application Made: (if yes,dote......... . ... 1 NojQ New Construction: Yes No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public.sewer_is availa6le,_w.ithin;200,feet.)r Septic Tank: Distance from nearest well --�_!!------Distance from foundation----/-p- ..-.Materiel----x te.d° Y _,P•�- P _.----. 19 No. of compartments--- - �-------------Size- k-5� ,9--*----Liquid de th----------�y------ ------ Capacity---- Disposal a acity----Disposal + Field: Distance from nearest well-.-' ..-Distance from foundation--_err. -__-.Distance„to nearest Ion line_-r s- Number of lines--r.---- �:�-- Length of each line.?-- Ira - th of trench--------------y----------------- x Type of filter material-:!G. c�- .....---Depth of filter material__--____--.-.-_y_rl'o�al. length---------- 4!------------------ 0 See age Pit: Distance to nearest well-----�;.—a-.------Distance from undaticn___,ea_---.-.DisAance to ne)rest•lof.li,ne---$�.-----.- 'p Number of pits---:. ----:=---L-'inin9--material-,_ -- Size:.Diameter:.2 --.Depth--- - ---------------- Cesspool: Distance from -nearest well----------------Distance from foundation....................Lining material------------ ----------__------------. ❑ Size: Diameter-----•--------------------------------Depth----------------------------------------- --------.-Liquid Capacity.........:------------------gals. r- Privy: Distance from nearest well-------------- ---------------------------.---_--Distance from nearest building---.-...--------:----------_-----_------. ❑ Distance to nearest lot line-------- --------- - ------ ---- ---------- - ------------------------------------------- ------------------------------------- Remodeling ---------------Remodeling and/or repairing (describe):--------------- ---------------- ------ -----------------------------------•--------------------------------------------------=------------------------- ! t 1 ---------------------------------------------------`---------- ----------------------------------------------------------------------------------------------------------------=----- ------------------- - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 Contractor) By----------- ----------------------------------- -(Title) -------- -- ------------ -- ----------------- -------------------------------------------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED•BY ----.�� ------ DATE,--.�? �� 1 '-' ------------------------- I. REVIEWED BY------------ -`--- - -- . DATE,�.`............. BUILDING PERMIT ISSUED 7 DATE--------------------- Alterations -------- ------ # ` - - - , Alterations and/or recommendations:--_ -_ _- •�� 4` � ��-.._----�:--� -. -------Y........ --- -------ter`- ----- ------- --� ---------------- ------------------------- .. ! I - -- ------------------ - ------- - - - -- I FINAL INSPECTION BY:..._C ---- $ ----------------- Date----g.-- .�- A-----�45------------------ i , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California . Lodi,California Manteca,California Tracy,California JJJi F.P.L^O.