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FOR OFFICE USE: ------ ------- ° ° ��4 0 ----------- -------- ---------- - ----------- ------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ...-•---------------- - (Complete in Duplicate) Date Issued ,,. This Permit Ex fres 1 Year From Date Issue 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_--------- --------� '------ ----------`S 1------------------------------------------------------------------- Owner's - `-----------------------------•---------------------- Owner's Name Phone. l �3v _s/C 5 ------ -------------- -------•-------•-------•---------------•---- Address-----••------ --------JY.:•2C---------- •- --- �'"Zls--------------n.-- '�� �- -- r- Contractor's .Name--------G� �"f 7Y/ / L�-----•---_-[ f /?-----•---- --X14.-----•-------------------- Phone_..`� Installation will serve: Residence l] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms Number of baths J---- Lot size ---- __ ---...K- .--I-Q-O------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: [if yes,date. ,-------.--------) No X New Construction: Yes ❑ No V 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 -.--------------------------------------------- i --------------- --------- Capacity ❑ 11 No. of compartments------------ - ----------- Size Lquiddepth Disposal Fiel �:• ` Distance from nearest well: .-Distance from foundation--_1 Q-.........Distance to nearest lot line---J___---.-.- Number of lines-----------k--------------- ------Length of each line---------90-------------Width of trench--------- 4--. �------- rid Type of filter material__,5_'AgP.Zf41;---Depth of filter material-----.-- .'_-----Total length------------------------------------------ Seepage Pit: Distance to nearest well--------------------_Distance from foundation-------------------Distance to nearest lot line-------.--------- a ❑ Number of pits---------------------Lining material--- - -----------------Size: Diameter------------------ ---Depth- ---------- --------------- - Cesspool: Distance from nearest well-_--------------Distance from foundation ------- ---...Lining materialy---.-_----_---------------. ❑ Size: Diameter----- ------ ----------------Depth------------------------------------------------ Liquid Capacity gals, i Privy: Distance from nearest well------------------------------------------ ------Distance from nearest building------------------------------------------ ❑ ----------------------- Distance to nearest of line--------- --------------------- + _ Remodeling-----a----n----d----/----or------r-e----p----a----i--r---- epainng {describe: - ---- ----------------`t�-----�`�- . . . - --------------------------------------------------------------------- -- ----- ------ ---------------------------------------------------------- - - i -------------------------------------------------------------------------- ----- --------------•-------•--------------•------------ ------ ------ ---- ---------------------------------- -------------- ----------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (�n _ -------------------------- ------------------(Owner and/or Contractor) (Signed)--------•--------"' - �,..��-- Title �`,.----- ---------------- ----- -- -------- - --- ------------------------------ (Plot plan, showing size of lot, location of system in reation to wells, buildings, etc., can be,placed on reverse side). FOR DEPARTMENT USE ONLY � DATE-.�;;d _P_.y ------------------------- APPLICATION ACCEPTED BY------- --0 X- -Z�4f--- - ---------- -------------- ----------------- REVIEWEDBY-------------------------------- ----------- - --- ------- ---------- - --- -------- -------------- - --- DATE------------- -------------------------------------------- BUILDING PERMIT 15511ED --------------------------- - ----------- ----------- --------- ------------------------------------ DATE.---------------- ------------------------------------------- -- ----------------------------------------- Alterations and/or recommendations:--.._--------------------- - ----------�----------�-- --- > -1 (o Date- J --- --------------- FINAL INSPECTION BY:` - 6�( ---- ------------------ ------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California