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FOROFFICE USE: f \ _ -----______________________------------------------ 3_�- APPLICATION FOR SANITATION PERMIT Permit No. .(__. _ ------------ ------------ - ----- (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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1&(-fc-60-2f ""'7.�{7 s - ,v��cis-s�rz.� UU � 1 JOB ADDRESS AND-�LOCATEON•- ,-1._---- _X---- _G------- `�7------- ---- -,�� ✓C.P.t�-.----_��QR _- Owner's Name-----------�G.l_-A—IsV4-" `-----y l/-i e T---------------------------------- ------------------- ---------------- Phone--- -- _4- - 7 - Address............--••----------------• -- ---- mph --�C'�f --------------- ---------�---------------•-- --------------------•----------------------------------•----------•--------------h--------• Contractor's Name ------A-14lCKf�----------------------- -----------------------------------------•- ----------------- Phone----------------------------------- Installation will serve: Residence M---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j____ Number of bedrooms __ Number of baths _ .__ Lot size ______________________ Water Supply: Public system ❑ Community system ❑ Private N-'oDepth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E) Clay LoamLWOF-] y El Adobe [[Hardpan ❑ Previous Application Made: (if yes,date___-----------------) No ��J( New Construction; Yes FHA/VA: Yes ❑ No Pl"' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f� Septic nk: Distance from nearest well__/____Distan from fo ndition-_--f�_`._._ Material----A ..4 IV No. of compartments------------- -- f .Size-,-,- ---- - -t-.Liquid depth------if, --------Capacity-••---r------ -- � Dispos Field: Distance from nearest well Distance from foundation----- -------------Distance to nearest lot line-------X_ l Number of lines_______ .__.________ ___Length of each line--,l+ ,lJ--_.Width of french..__--____�___-___________-__ ^• Type of filter materialTs~1LOC1Depth of filter material__- j _--.Total length___________� (_(________________ - Seepage Pit: Distance to nearest well-----___--------------Distance from foundation-------------------.Distance to nearest lot line----------------- El .__.__- -..._❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth-.--.---------------------------- Cesspool: Distance from nearest wefi-----------------Distance from foundation-- 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):--------- --------------------------- -------------------------- ------------------------------------------------ --------------------------------------- ------------------------- -------------------------------•-------------------------------•-•-------------------------------------------------------------- --------------------------------------- ---- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc�ates, and rules and regulations of the San Joaquin Local Health District. (Signed - --- -- --- ---------- ---------------------------I-----------------------------------------(Owner and/or Contractor) Y•----------------•. (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 BY--------- --- ------ -------------------- DATE------- REVIEWEDBY----------------------------------------- - ----- ---------------------------- --------------------------------------------- DATE----------------------------------------------•----•------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- ATE.--------------------------- - ------------------------------ 1-6,t d � l Alterations and/or recommendations:____�..-_I_:lasa -moi-- -- -•--- --t.-----��-�.�u----+-a1ret.- v ----------- ' d 4`• -------------------------•--- -------------------- .PrLt .- FINAL INSPECTION BY:---C�-....--�-- - ---------------- ----------- Date-----Y - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124.Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.