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APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------- --------------- (Complete in Duplicate) ------------------- This Permit Expires 1 Year From Date Issued Date Issued �eXY 1 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. JOB ADDRESS AND LOCATION 70 .__.- 3 -- -- - / �� A �^ r Owner's Name-------------1;<7A1,ff__S ------ Address ---- Phone ------------------- Address fi 31 _1 �---------10A_j Al o ��-°-z-L___. ', ------------------ Contrac:tor's Name-----�^ e��1." '_ Jif -----------------------------------------------•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ® Other ❑ Number of living units:h:�~._ Number of bedrooms/ _- Number of baths-�_ Lot size ____c -- Water Supply: Public system ❑ Community system ❑ Private © Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------ ------ No a New Construction: Yes ❑ No g FHA/VA, Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation------------------. Material______---_--.-..______-_"___.-_.__"-__.._--_"_". ❑ No. of compartments--------------------------Size---------------------------------Liquid depth----------------- --------Caaci Disposal Field: Distance from nearest well_. _74$�_.._Distance from found ion.--_--- .Distance to nearest lot line-----0 ---- Number of lines- _--__-_1..." ___________Length of each lir __, _'...____.- Width oftr h.___ __ Type of filter material_ -Depth of filter material----/Y-----------Total len ._" )_5______________ Seepage; Pit: Distance to nearesf well_l0t! .._._,;Distance fr foundation___ -------- Distance to nearest lot line__.��✓ `� KNumber of pits------- --------------Lining material--- Diameter-----"-.--------Dept h---s2__-----_-_--.-_.._____ W Cesspool: Distance from nearest well,---------------Distance from foundation--------------------Lining material__.____:.._.__..__.-____---._____-.-_. ❑ Size: Diameter----------- ----------------- ------Depth--------------------------------------------------.-Liquid Capacity-- --------------------gals. t Privy: Distance from nearest well ___._____________________---------------------Distance from nearest building------------------------------_---_---_--. ❑ Distance to nearest lot Iire----------- -------- -- Remodeling and or re airin fdescribe1:------/4�//------ -�� --------------------------- -------------------- --- -A------ ------- ------- --------- ------------------------------------------------------------------- --------------------------------- -------------------------------------------------- - - --------------- --------------------- -------------- .o --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stated rules and regulations of the San Joaquin Local Health District. , j , (Signed)--------------------- ic--S' �� -------- --- --- ----------- ---------------------- Ow and/or Contractor) r By:--------------- --------------------------------------------------------(Title)- -- -- -- . - I (Plot plain, showing srze of to , location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__.___-. .. - -----/-,0".--- DAT ..... �� ..._� �-5/------- REVIEWEDBY ----------- --- ------------------------------------------------------------------------- -• DATE w, BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------I----- DATE-------- ------------ - _ ` ----- TL----_-- LLd/1coL{Alteratians and/or red - 1 _- ---------------------------------------- ----------------------------------- - ------------------------------------------------------------------------------------------------------------------- ------------------------- ---------I--------------- ----------------------------------- --------------- -----------------_ -------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------- - - -- ------------------------------- FINAL INSPECTION BY:--- ---- ---------[ - -e_..w. Date........ 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.CC. - it 9