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FOR OFFI61 E•USE-r- _ _- --,-"_________________„",-"","„--______________________ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -------------.-__----------- (Complete in Duplicate) Date Issued --_ -- --------- This Permit Expires 1 Year From Date Issued 21�fS- 020-1tv Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described This ap lication is made in compliace ith Cou ty�Ordinance No. 549.- JOB ADDRESS AND LOCATION;- r ��' ?`QG. / Owner's Name ��D <1 � /V _ - ---- - --------- Phone- `5-�• 91- / Address--------------------------- - - -----------I ------- ------- ------------•--'1`-� --------------------------------- --------- Contractor's Name----- _._..-- % Z f P � f Phone_ 5 Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ M2el ❑ Other ❑ Number of Jiving units: Number of bedrooms __-`_ Number of baths __-____ Lot size ____ -_--________-___"._ Water Supply: Public system ❑ Community system ❑ Private 2f- 15epth to Water Table/-eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 19--'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_.--------,--------1 No 8--New Construction: Yes ❑ No E]--FHA/VA: Yes ❑ No [9--•- TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or_cessp6oIpr6rniiff6d if public sewer is available within 200-feet: Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ___----._____-______-_____________-__-_____. f” ❑ No. of compartments-------------- -----------Size------------------------•-------Liquid depth--------------------------Capacity----------------------- l _ �. Disposal Fi Id: Distance from nearest wel _-"-_Distance from foundation-6:;W to nearest lot line_l� ____ 4� 0Number of lines____________.____ _ "_______Length of each line____-_7 - �- Width of trench------ ----- ___________"___ Type of filter material-__ /L�Ot!/e-Depth of filter material _ ---_______Total length___-___ ___�________________ Seepage Pit: Distance to nearest well_____-----------------Distance from foundation--------------------Distance to nearest lot Sine__-"_"_---------- ❑ {dumber of pits----------------------Lining material-----------------------Size: Diameter----_------------------Depth-___----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----_--- ---------Lining material_______________________"_____________. ❑ Size: Diameter----------------- --- - Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------- "_"--__"-Distance from nearest building-------------------------------------- -- ❑ Distance to nearest lot line.......--- -*-------------------------------- -------------------------------------------------------------------------------- Remodeling and/or'repairing'(describe):"- _." -____ __ __ ,' ______�\- 'lf_f `.-�________� - _-'�________ �. ---A---- ------------------------------------------------------------------------------------------ _______________________________ ______:____----______..____ .. ___ ________________________________________________________________________________________________"___-__ 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 rule?"'nd regulations of-the San Joaquin Local Health District. {Signed)------------------------------ C-- " ----- w rand/or Contractor) B -� — .- ---- - ------------------------= { ttl 1 =-------- Y7 - w T. .- ' (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 DATES ------------------------ REVIEWEDBY----- ------------------- ----------------------------------------__------------ ------ -------------------------------- ----- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ --------- DATE------------------------------------------------------------- Alterations and/or recommendations:-- -----� --`--- ---�---------------------------------3-------c---t---------r------------------------T-,-------->-F--�----�--3--------------I-A--V- --- ---------- -- s ---------------- -------------------------- OWAI_F_=JR-------:5A �----- ------------7-4_R_,.o---------------------------- --------------------------------------------- ----------- - 'I FINAL INSPEC Date- - -----------ZS_.__' .. . __.".__."._--------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1:,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.