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FOR OFFICE USE: 1 r J ( f (. ) �, L S - -- --`----''� Permit No.`� "tf APPLICATION FOR SANITATION PERMIT --------------------- ----------- --------------------- (Complete in Duplicate) Date Issued ---------------------------- -- --- This Permit Expires 1 Year From Date Issued 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. red JOB ADDRESS AND LOCATION . -r_�// --/!�� f �/ / -------- 111'0 i��----W� --- �/ Owner's Name------ fZ---- - _�' ' ----------------------------------------- ----------------------------------- ----- Phone-- -- •-------- --•- rwrop Contractor's Name------- -- -"7 1-�?!77------------------ ------------------------------------------- ----- Phone------------..------------------- Installation will serve: Residence El"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __ Number of bedrooms A--- Number of baths A-_ Lot size __ - y Water Supply: Public system ❑ Community system ❑ Private R?"ODepth to Water Table Sf - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P-lHardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes &INo ❑ FHA/VA: Yes Z�.— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public)ewer is available within 200 feet.))} Septic Tank: Distance from nearest w I_ ( ______Distan� from f ndation__ l�---__----.Mate�al- -- //�� p� �` - -- -------------- No. of compartments_-------.----l...Size.(✓--"!. __�iquid de`th-----�_--- - -- - --Capacity/ ------ Disposal Field: Distance from nearest well_ ..--..-Distance from foundation---- ---.----.Distance to nearest lot line--__-.__ Number of lines---.-_f------- --- -. -- Length of each line-- �----------------Width of trent r p , Type of fitter material�f Depth of filter material-- ----.-Total length--- -- ------------------------- Seepage Pit: Distance to nearest well__,��_----Distance fr m fo dation_-,e-' "_.__.D'st e to nearest lot line--b�. ------ 'Number of pits-----�------------Lining material/ t -Size: Diameter_- �..--.---.Depth-r` r - Cesspool: Distance from nearest well----------------- 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)----------_JLC -- --- ---------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------- ------------------------------------------- 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------------t-- -- ------------------ 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, a d rules and regulations ofithe San Joaquin Local Health District. (Signed)------------- `~ ------------------ a----------- --------- ---------------------.-.--tE) 9F-eF Aor Contractor) Tale By:------------------------ ----------------------------------------- --- ------- ------------- --------( � ) r (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY L DATE-----6 J �/ �'� �? ----- - REVIEWEDBY--------•------------------------------------ --------------------------------------------- --------------------------------- DATE------------------------I----------------------------------- BUILDINGPERMIT ISSUED-------------------------------- ----------- DATE-------------------------:-----------------------V---------- Alterations and/or recommendations:.-.-__- q' =' - -------- ---- i .----- ------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------------------- FINALfNSPECTION BY:----.< —— ------------ Date-----------------------------------------------------------------------=------------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.F.1:o. /