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FOR OFFICE USE: r � T5' ------------ --------- .-------.----------- 7 -------------------------......................-------- APPLICATION FOR SANITATION PERMIT Permit No. ___---------- 7 - -------------- { ------------------------------- (Complete in Duplicate) • ____ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct ad in II the work herein described. This application is made in cow ;once with County Ordinance No. 549. /�� JOB ADDRESS A OCA T1ONI ±!1 . `�7'- = °i - �' C� �V/ �' y�11" Owner's Name ��? Phfi anZ 7 ----- - ------------ Address------------------- f�{ /0 / ---- --- p ! Contractor's Name_.-1'�+�___. _`��A..ii1 '.� Installation will serve: Residence �Ipartmenf House ❑ 'commercial ❑ Tr iler Court ❑ Motel ❑ Other ❑ Number of living units: ---k Number of bedroom;��=E] ber of'�aths ---/-- Lot size --_ __�._ L.l.l ---- ---------------- Water Supply: Public system El Community system Depth to er Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ C y ❑ Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date-----------_--------a No ❑ New Construction: Yes RNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6jic sewer is available within 200 feet.) ---� Septic Tank: Distance from nearest Distance from foundation-1-C ri.._---.--.Material_-- No. of compartments... _______.____ _ Size'�.7GQ__Je� ._.---Liquid depth___�6___ --._;----capacity____ _ . Disposal Field: Distance from near st wel .__. Distance from foundationDistance to nearest I fli, _ _.__ e----_ Number of fines_ -------Length of each line/_r__3_x__�sfzO__-.Width of trench----- h__'7............... Type of filtermaterial_--- --- ------ p g Depth of filter material_.-_-_l�� -Total length A/ _--------- Seepage Pit: Distance to nearest well-_________-_ -------Distance from foundation____---------------Distance to nearest lot line----------------- F] Number of pits----------------------Li ing material-----------------------Size: Diameter-----------------------Depth-------------------------------.- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material-...-_ ---------._.--_----.--. El Size: Diameter--------------------------------------Depth---------------------------------- -----------------Liquid Capacity_ gals. Privy: Distance from nearest well--------------------------------------------- ---Distance from nearest building---_--____________.__----..._.._-._._. ❑ Distance to nearest lot line---------------------------------- ---------- - -------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------- - - ----------------------------------------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------------------------------- ___..- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ---- t --------- ------------------------ ---------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that-+have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, arLrules and regulations of the San Joaquin Adlings, h District. 2ar� & (Signed) 9EP i -TANK--SERViCE------------ ------- ------- ---- ------------ --- ---------------- ----------- -.Ow Contracfor) By:-2 Ir..M1neL�►va�,-• kl0.fa-�4il------------- --- ------------------ ------------ Title)---------------- (Plot plan, showing size of lot, location of system in relation to wells, bc., c n be placed an reverse side}. FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY--------------------------------------- ------------------ ATE-------------q 77&— REVIEWEDBY--------------------------------------------- ------------------------------------- -------- ------- - ----------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------- - ------- ---------------------- DATE----------------------------------- Alterationsand/or recommendations:------- ------ -------------------------------------------------------------------------------- -----------------------------------------------------•--------- ---------------------------------- ------------ -------- --------------------------- ------------------------------------------------------------------ ------------------------------------------------ ------------------------------- --------------- ----•-------------------------------------------- -------------------------------------- ---------------------------•--------- ------------------------------------------ -------------- ----------------- ----- ---- --------------------------------------------- --------------- --------------------------------------------------- ------------- - ---------------------------- FINAL INSPECTION BY:----- f.I(W— -------- ----- ) Date-------- -121 . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F-p.c o.