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FOR OFFICE USE: -�• __�1..51-------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _1� .5 ... -------------------------------------------------------- (Complete in Duplicate) Date Issued Z_�-11_Sr. ..........._ ---------------------------_______________..__ Thus Permit Expires 1 Year From Date Issued Application is hereby made to the SanJoaquin 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. JOS ADDRESS AND LOCATION_____r�_,Q____ � --- -=------------------ --------------------------- Owner's Name ._ •-•/7__ ------------- ------------ --------- Address------------------------ ------- Address------------------------ 3 ------ -------------------------P--h--o--n--e--.-_---------_------------�---1----.-9----_- " ti 5 ----------- : sContractor's Name � T...._Z-11��---•----•----- ---------------------------------------------- Installation -------_-._.--------•--•-------------------Installation will serve: Residence JX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑~ Number of living units: --f---- Number`of bedrooms.-3"Ni mber-of baths;a_/. Lot size ____,gi _.____._____.___.______ 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 20 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date.----------,>-..__-_1_ No [g New Construction: Yes ❑ NoX FHA/VA: Yes ❑ NON TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt___---:----------Distance from foundation__________________Material----_------_--------._______-,__----______.____. ❑ X/ST//Y6No. of compartments------- ---- Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Field: Distance from nearer#well._..-_--__-- Distance from foundation__/40_____-----Distance to nearest lot line_ --------- ®— '� � " Number of lines-----______t.-__ -_______Length of each line___`.:_ Width of trench------CA_ _��______________ Type of filter material:_,__-{_ __Depth of filter material----f_ -------------Total [ength_______1!�___________„•_ _^_______ r Seepage Pit: ”` "Distance to nearest well -'-__-------Distance f7r n foundation---ZO---_____ Distance to nearest lot line__:.______ .iVumber of pits---------- --- r/ i1 _Lining material____ ,fj _.Size: Diameter_' ; - Dept h___ .-T"-/C71-."_ Cesspool: Distance from nearest well-----._.__-.1Distance 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)---_./`�'_ __`..._ _._______ - �__ l_N_ ___.___ .__ J i -------------------------------------------------------•--------- --------------------------------------------------------------------------------------- -------- ----------------------------------------------------- ----------------------------------- ----------------------------- --------------------- ----------------------------------- -----------------------------------------------------------------------•—-------- -----------------•----------------------------------------------------------------------------------- ` - - -- - - -- - -- ----------------------f (------ --------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 and rules and regulations of the San Joaquin Local Health District. (Signed)---------- -��-h,�`l _J , -- - ------ ----------------------- ------------�-------- ner and/or Contractor) EY� A h�°`°- (Title) - ------- ---- --- (Plot plan, showing size of lot, locati of,system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ..;.---- ------------------------ -----------• .---• - ----- ------..DATE.._ REVIEWEDBY--------------------------------------------------- - -------- ------ -------------------------- DATE--------------------------•-----------------•-.._-------- - - BUILDING PERMIT ISSUED------------------------------------------------ - -'------------- =--------------------------_..__ DATE----------------- --------------- Alterations and/or recommendations:-- f c------ ---- `- -\----`i-9 ---- �-------- �.��------------------- ------------------------------- - --------------------------------- - - ----- ------------------•----------------------------------------------------------------------------------------------------------------------------`---------------------------------------------------------------------------- l ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ I FINAL INSPECTION BY:---- --------------------- ------ -- Date - z' - -------------------------- ---- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracyr California F.P.Co.