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F R OFFI,CE USE: --------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued - ------------------------ - This Permit Expires 1 Year From Date Issue !S,/ 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. �� Q_ 5 ,.t [ ,� " N -- - • ✓j°Y�`Q— JOB ADDRESS AND LOCATIO ------ 1. ':_� �� .,� Owner's Name---�-f? 4 --------------------------------------------------- Phone. :__..._ -� --• Address_ ��7__-- Phan V Contractor's Name..-_� �__ _v`. /�y,( e �7� � _- - Apartment House [ICommercial El Court ❑ Motel [I Other ❑ Installation will serve: Residence � Number ofdivint� units: __r._ Number of bedrooms _ _--- Number of baths _./--- Lot size ' -..---� r a 1 . Water.Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. C]laracter of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [I Clay E] Adobe Hardpan ❑ Previous Application Made: (if yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION'AND SPECIFICATIONS: V I (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) ' 1 rA Septic Tank: Distance from nearest well__� Q___Distance from foundation___�f _____ _-. Material i No. of compartments -Size_ -�r � r----Liquid depth-----X P'_'---- ---Capac,tY----------- --�------- 1 1. 3 ,�6-------.Distance to nearest lot line.___ O Disposal Field: Distance from nearest well. --- Number from foundation__. __ Number of lines_____ ___ _ _ ______ Length of each line________. .Q -_--.Width of french------- .----------- i De p h-"---------------- Type of filter material--__. ---'s. _._ pth of filter material-_-_-ZQ--�----Total length_______.__ 's Seepage Pit: '•Distance to nearest well-.--_-_--- Distance from foundation____________________Distance to nearest Cot line__._.___.._.__.. ❑ Number of pits---- :----------------- -------- ---- Lining material----------------------.Size: Diameter---------- ------------Depth-------------------------------- i Cesspool: Distance from nearest well-----------------Distance from foundation._.._----.-_--_-__.Lining material---------------------- --Depth------------------------------ ------------------ Liquid Capacity----------------------------gals. Size: Diameter---------------------------- Privy: Distance from.nearest well-----------------------------;___--.-------------Distance from nearest building_--_-_---------__---__---__-__-_-.-._.--- ❑ Distance to nearest lot line----------------------------- -- ------.•'----------'--------•--- •------------------- y - repairing (describe):----------------- --------------------------•------••-------------------------•-----------------•----------------- -------------------- Remodeling and/or . _ _________________________________ _________ __________________________________________ ,. f _ ---.--•----------------------------- --------------------------.--.--_-._-_-_-_-___--__ ____.______._..________.______.____._______._______. - - ------ --- - ---------------•r.------------_ -- '- 9 I hereby certify that.1--have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws j rules and regulations of the San Joaquin Local Health District. l !ro Contractor] (Signed) ----------------------' By:6E�'r,G-sn►tr sEal�lr6----------=`----------------- (rile)-----------------•- ----------- ----------- .............. Iif s stem in rely n to wells,'bui ings, etc., can be placed on reverse side]. (Plot plan, tPf0fH y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- = DATE------------G_AA------------------------------------ iDATE------l•---•--------- ------ ----------- --------- REVIEWED BY-------- ---------------•------------ ----------- 11 BUILDING PERMIT ISSUED -' --------------------------------------------------------- DATE Alterations and/or recommendations:------------------ I-----•---------- - ----------------------------------------------------------- --------------------------------- -7 .----------•-••------------ - = - ' ---------•------------------------- -- ---- ---- ---.----------------------------------------•-------•------------------------•------------------------------- ------ --- -- --- - --- _. ----- - --- - -- --------- --- � Date------- TM. 1--------- ---------•-------------------- FINAL i NSPECTTON .. . SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 124 Sycamore Streot 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California r I E6.9 REVI6En e•59 f'.P.0�•8M fi•6tl ' I