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FOR OFFICE USE: ------------- ------------------------------------------- ' APPLICATION FOR SANITATION PERMIT Permit No. d _:-`---- -------------L------------------------------------------ (Complete in Duplicate) Date Issued _ ____-----�__-- ------------- -------.-------------------------------- _- This Permit Expires 1 Year From pate Issued Z-i sl,- 0 i--v-7 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. �� . rt.l�"c'ti o S-44 1 &-k iJ JOB ADDRESS'AND LOC TIO - �' "-- ----------------------- S ----- - - ---------------"---- E _{moi- - -- --- 1� --- ��-- -- � _ Owner's N me ----------- �_a_//_ L� -------------------------- -------------------- - - ----------- -� Phone-- ---`-=�� --- / , Address--1--------- ---------------------- ------ .xContractor's Name-- - � Z2_ _,__ ---------------------------------------- -----------------------"----------------------- Phone._a `^ o I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '7 Number of living units: ----- Number of bedrooms ?___ Number of baths _',- -_ Lot size ---%.47f2_e_1A �_1--------------------------- Water Supply: Public system ❑ Community system ❑ Private;M Depth to Water Table jh_ ft. "Character of soil to a depth of 3 feet: Sand K Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan -Previous Application Made: (If yes,date-----------_--------) NoNew Construction: Yes ElNo FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r+ 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet,) -'Septic Tank: Distance from nearest well____-!17 .__Distance from foundation----/[--------Material------------------------------------------------ 112-1-7/IQ- No. of compartments-------------- -----------Size-------------------- Liquid depth-------------; ----------Capacity------------------ vis' ` r - e Disposal Field: Distance from nearest well-_-. -._.Distance from foundation-_:___e.P-___---Distance to nearest lot line____tbr___-_____ / �� Number of lines-----------------------------------Length of each line.------------------------------Width of trench----------------------------------- Type of filter, material------------------------- of filter material------------'_t__4-___-_Total length_________________________________________ t4 ' Seepage Pit: Distance to nearest well._.__.��_____Distance from fopwndation-___ _ ________Distance to nearest lot line-------'��_ Number of:pits----__Z-----_-----Lining material--_ ..Size: Dilame�err ,, , .__ --,,e�ptlh-- �--------- ------------- Cesspool: Distance from nearest well_________________Distance from foundatiorf Lining materia T--------------------- -_ - -------------- ❑ Size: Diameter- - - ---------- - - - ------------ -Depth--------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we]-----------------------------------.-------------Distance from nearest building--------------------_________________.__. p Distance to nearest lot line-- ------- -------- --=-- ------------------------------------------------------------------------------_------------------------ Remodeling and/or repairing (describe):____-.-f �_ _---`� f _________________________________-____________-____________________-_______--_-______-__--_______________ -----------_-------------------------------------------------------------------------------------------------------------------.-----------------------------------------.------------------------------------------------- ._____ __________________________ "-____ ________ __ _________________ _________ _ _______________________ _____ __ _ ____ ____ _____-_. _--_____-__ -_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S a laws, and rul and regulatio s of the San Joaquin Local Health District. G c (Signed !� Owner and/or Contractor _ By:------------------------------------------------V--------------------------------------------------------------------------------(Title)--------- -------------- --------- --- (Plot plan, showing size of lot, location' of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -- ----- ----------------------------------------- DATE------------ "-L -47----------------- REVIEWED BY-------------------------------- ------- ------------- ------- --- -----` -------------------------------------- DATE------------------------------------------ ----------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------- --------------------------------- DATE------------------------------ -------------- ---------- - -- Alterations and/or recommendations:-----------------------------------------------------"--------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------------ ----------=-----. ----------------------------------------------- ------------ -----------------------=-------------------- ----------------- --------------------------------------------------------- ------ -------------- ---- ----------- - ------------ ----------------------------------------------------- --------------------- ------------------------------------------------------------------------------------- FINAL INSPECTION BY L . ----- %° Date----------_7--'" J77 ---------------------------:--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.