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FOR OFFICE USE: -- ---------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------------------- ---- {Complefe in Duplicate} Date Issued ----------------------------------_.___._.!__-----_'-._ This Permit Expire's 1 Year From Date Iss6ed Application is hereby made to the San Joaquin Local Health District for a permit to Lristruct and install the work herein descrbed. This,application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND 'LOCATION +S 5 ----M Q_ r �l / --------------- v ------------------------------------------------- Owner's Name---- ---------- T ---•------ 6.4v1- r------------------••------------------ - --- --------------------------- ------- �a Phone--TLS `S Address - " . F _-.---- pF _ t1 Contractor's Name-----1------- Ckt1_5�--------6 - - f -------------- Installation will serve: glResidence Y Apartment Ho�ise ❑ Commercial [:] Trailer Court ❑ Motel [:] Other ElNumber of living units: __ Number of bedrooms _Z?___ Number of baths _ Lot size -------------------------- Water Supply: Publicsystem Community system;E] Private ❑ Depth to Water Table A7.a- ft. ;mss. 11 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date------_____________l No New Construction: Yes ❑ No FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) [ Septic Tank: -y�j Di stance from nearest welL_____.______t..'Distance from foundation____I_____________Material------------------------------------------------ I ❑ e'41& ^6 F of compartments---------;' -Size-------------------------------Liquid dep.'h--------------------------Capacity------------------�--- Disposal Field: Distance from nearest welL .N6_ A Distance from foundation.-.- _._____.Distance to nearest lot line ___1_ �� Number of lines________ _____J_ Length,of.eachline___________y®_'..______-Width of trench....__.___ --_._______._ hType of filter material___s.S,_, CtL°.ICDepth of filter material________1s -- ..Total length------------------------ ___�___ 1� € t 1 rd S + 1S T Seepage Pit: Distance to nearest we IP.0_V Dis once"from foundation___ ____.Distance to nearest lot line__.-_ ' ! s. t IRpL� Nu%ber of pits___.._.___..._____.Lining mateha�l5 % �CSize: Diameter._.______. -____Dept h___________________3 ____..__ Cesspool: Distance from nearest well__----?---------Distance from foundation.... --------------Lining material.........-------------------------- __. ❑ Size: Diameter- ----------------------k-------.Depth-------------------------------------- ------------.Liquid Capacity- -------------------------gals. FPrivy: Distance from nearest well-______ ____________ _._.__ _. __Distance from nearest building._.______.___________________..____------ 0 rte.,..._:��.......-,........:.:. .^ �------------ -__ .._-:-w ❑ Distance to nearest! of line --------- 'Tl Remodeling and/or repairing [describe= � YxS ' -------�Y�'r ---------------------- ------ r• (° -----•----•--------------------------- -------------------- ----------------------------------- - I-------------- -------------------------------------------- •(------------------ --------------- ------------------------------------------------------- J------------I--------------I---------------------- --------- -------------------- -------- ----------I--------------------------------------------------------------------------- M I hereby certify that I have prepared this appli a'tion anYd+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. I. ------------------ ------Owner and/or Contractor (Signed)------------------- _ i "--------� { / ) � `- Title-------------- ----------------- ----------------------------- By:---------------- ----- ------ --- ---------- -- ---- � s { ) ` (Plot plan, showing size of lot, location of system in.rel ,ion fo wells, buildings,!etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY} APPLICATION ACCEPTED BY--.----_--'---_________ _____ I -- DATE___ -._��T__�� ------------------------------------------------------------ - -------------------------------- REVIEWEDBY--------------i------------------ ------ - - --------------------------------- --------------------------- --- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------- I-----------) DATE Alterations and/or recommendations:._________. _. ----- - ----------------------------------------------- 7. - � 3-3----- $ - ----------------------------------------------- i ) i t' i y ------------------------------ ------------------- ---------- -------- ---------------------------------------------- --------#------------------------------------- ---------------- -------------- y f -------------------------------------/---------------------------------------- ------------ fU r - FINAL INSPECTION BY:.. .. - - --•--------- ---- -------- ------------ Date------- ---- - --- ----------------------------------- i 4 SAN JOAQUIN LOCAL HEALTH DISTRICT E 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street lr" Stockton,California Lodi,California Manteca,California Tracv,California - I.: