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1- '.C)FFICE USE: ..�. sad --------------- -----------__ -------------.._.__._______..._.____- APPLICATION FOR SANITATION PERMIT Permit No. ....�,�J._ --------------- ----------- ------ (Complete in Duplicate) T ----------------- This Permit Expires 1 Year From Date Issued r" 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 AAD LOCA710N - _ j .Q f G! f----- 9---------1� �Dlt� ��---- -- -------------------------- Owner's - _Owner's Name- = r='�`V �=� • � ,w . -• ---------•-•---••----------------- - -- -------•- - - Phone----••------------------------ n G' rs r� N]��d h��Me 5J �;r3i 3�/�� Address,-..... - Contractor's Name--- lX-lt. ... F �� - O ---------- ----- --------._. Phone/_jq__"._5?---7-------- Installation will serve: Residerfce ®partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _J__ Number of bedrooms _ __-. N � ^� Number of baths ___7___._ Lot size ___�.�_______�--��-a._--------------- Water Supply: Public system ❑ Community system [] Private ET---Depth to Water Table -------- ft.' Character of soil to a Idepth of 3 Efeet: Sand ❑ Gravel ❑ Sa Loam ❑ Clay Loam ❑ ay ❑ ,Adobe Hardpan ❑ Previous Application Made: (If yes date------------ -------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ®' TYPE OF INSTALLATION AND SPECIFICATIONS: ,k�,, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W-. Septicank: Distance from nearest well___�P�___Distance f om foundation__/0_�______-_Mat rial_ �4 /�TQ� No. of compartments _ Zr'- e____ _ p - - - - - --� ��_��.Liquid deptli-=--•�.-- ---------Capacity-f-�--�-,�/--- N Disposa field: Distance from near st well___ _ Distance from foundation___ _ �____.Dis#ance,to nearest lat line-.__f O Number of lines_-- f - Length of each line Width of trench_.-----. t Type of filter materia__--__e '.�_Depfh of.filter material___�_��-_'---__ .Total length-------- --------------- -, Seepage Pit: Distance to nearest well ____ +Distance from foundation------------_**___Distance to nearest lot'line_______________ ❑ dumber of pits------.------ -------Lining material----------'------------Size: Diameter-----------------------Depth- _' ---------------------------- Cesspool: Distance from nearest well-________________Distance from foundation_------- ,_______...Lining material___________________._____________.___. ❑ Size: Diameter-------------------------------- -----De th-------- _ P p _ - ---Liquid Capacity --- -------gals. ❑ Distance to nearest lot line_____--__-_--_:_____ --- Distance from nearest building______________------------•---------__--- Privy:- Distance from .nearest well__.__ ------- ------------- _ ---1------------------------"----- --------------------------' Remodeling and/or repairing (describe): _____ ___ ____ _ --------------- ------- --------- ---------------------------------------I------ _, �• t_ 1 -----••----------------------- ------------ "' I = -'--------------------•--=---------------------•-- ------------------•--- = l r.�---T-_ ,y ---•-------•------- - - ------------------------ ---------------- - -- i 1 y -----------------=------------------------------------------ ----------------------------------- -----------------------•---------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta 1 s, and r s and regulations of the San Joaquin Local Health District. [Signed -----• � {Title_- ----------- ------------------------------------------- BY: ( wner and/or Contractor) -: ='Y:--------- -- •- ---- iT p (Plot plan, sh 9 size of lot, location of:system in relation to wells, buildings, etc., can be placed on reverse side). 'l I FOR DEPARTMENT USE ONLY . ------------------------------ :- _ DATE r APPLICATION ACCEPTED BY---- -----�--_Y--------- --------------------- ----- --- 9. �` .� . REVIEWED BY------------'---- - - ( - - DATE BUILDING PERMIT fSSUED - ---- _ DATE--------------------------- f Alterations and/or racornmendations: -------------- ------------- -------------------------- - , --- - ------ -------- --- - ------------------- -----------------------------.------------------ - ------------------------------------------------- 1 yf FINAL INSPECTION BY:.- ----------- -- --------------------- -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'153 F.p,CC.