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APPLICATION FOR SANITATION PERMIT Permit No. ---_- •- `�7 .i (Complete in Duplicate) Date Issued r - i . . Joaquin Lova! Health District for a permit to construct and install the work herein described. Application is hereby made to'the San This application is made-in"compliance with County Ordinance No. 549. - n. 0 JOB ADQRESS A LOCATION.._:} -----------------------------------------• -------------------------------------------- f� ---- --- - ---- Name---- - +- f -----.------- ---------. Phone---------------------------------- Owner's Address t ------------------------------------------ ---------------------------1 ----------- -----------(- ----- ;. Phone------------------------ ----- Contractor's IV�ame-- •_•-- -•--•-- - -.�-—, ....---••----------- --; ------------------------ Installation ------ -------------- --------------------------- Installation will serve: ResidenceApartment House Commercial .❑ Trailer Court ❑ Mofel [-] Other ❑ ; i, f bedrooms ,S Nusmr of _ -- Number of as :/_ -_ --_1,Ji�J-0- Number of living"units: --� „• baths Lot size- 4t�_ tt; Water Supply: Public systern'�Comriunity'system ❑ " Private C] Depth to Water Table _ Character of soil:to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam E] Clay Loam El Clay El Adobe a Hardpan E] 1 Previous Application Made: Yes El.i• No New Construction: Yes No E] FHA/VA: Yes ❑ No El TYPE:OF INSTALLATION AND SPECIFICATIONS: t (No septic tank:or`cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest wel Distance fro foundation. �---------Mater al---____------_-- .- No. of,compartments-----T�-- - Liquid depfh------- -----------------Capacity-_ �- -------- compartments ---.-- �. Size , - -._ (/�) ❑ K Y Disposal Field: _ fame from foundation--3-- Distance to nearest lot lin( -.---____. Distance from nearest weli� Dist N6m8erxo4line4y_.----__-r- Length of each line-------- �� Width. of trench. Type of=filter material-$Cry- e--:---,---DEpth of filter material---- ----------Total length.:-•-- - '}---•---------------------- a - _ ' is '� Distance o foundation` ! _-_ Dista e to nearest lot,line:- See a e Pit: �� Distance to nearest well �_i_ t h �g . �n *Number of pits --fLi ing ma eriai_ v-- � Diameter- Dept Cesspool: Distance from snearest-well__---------- Distance from foundation--- ------------- lining material-- .-------------------------------- F-1Size: Diameter-----------------------------------------Dep h =----------------------------------'----------Liquid Capacity-------- --------------------gals. Privy: Distance from nearest well------------------=- ------- - ` Distance from nearest building- -------------------------- w� ❑ F . wSr _.-- � S. e. .� .Distance to nearest lot Dine"- ----- ----- -- - ----------- -- -------•----- e .. • 4 - r T-X_ t i 4— Remodel g_and -or repoi ing ,(describe - ---------------- _ t'f .�► ----- - ---- -------------- ---- ------- V ------------------------------------ r - -•----- --------------------------------------------------------------------- ----- ----------------- I hereby certify that I have prepared this application and-+haR the work will be done in accordance with San Joaquin County j ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.7 AZ, M1 T x __-_(Owner and/or Contractor) (Signed]B3y. ------------ - ----------------F------- ---------------------------- i ------ ----------------- (Title)--------- - ---" --------------------------------- ' (Plot plan, showing size of lot, location'of system in relation to weAs, buildings, a+.c., can bephac'ed�o' reverts se side). "FOR"DEPARTMENT USE ONLY - i --------- DATE------ -------- --------- APPLICATION ACCEPTED BY --- . --- / 1. ,, REVIEWED BY--=---•-----=--- ------------ - -- ------ DATE. d�-F�-- ------------------- BUILDING PERMIT ISSUED---------- ---- : _w -;- -, ----- -------------- DATE----------- '�---- Alterations and/or:recommendations-------- -- - -- -- ---------------------•`---------•---------.-.--------------- - .. = - - ----------•-------------------- -------------------•----------- -------- C -----------------------------•-.---- •---•------=--...------------------------------------- --- -- m---- -- :..---------•----- ---------------- -- " l U ------------------------------------ FINAL INSPECTION BY:.-_C-.t �r�--"�.�s" _ ,. Date-.:. :< w SAN JOAQU,IN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-7--2M . Revised 1.57 F.P.CO.