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FOR O FICE USE: --_ - ___ x 41" ------------------------ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._../_._7 � ------------------ --------------- (Complete in Duplicate) Date Issued ---�, -------- _-____�-�-------------.----------- I 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 c pl' e with County Ordinance No. 549. , JOB ADDRESS AND LOCATION.__ ._.. Y f Owner's Name` �j� ,,Z th t- Addresst% 1 ::. --------- -------------------------------------------------•-•-----••---•-•-----•-------- Contractor's Name-_ . --------------------------------- Phone --•---. Installation will serve: Residence [!r"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • Number of living units: __l.._ Number of bedrooms _--e. Number of baths -. Lot size Water Supply: Public system ❑ Community system ❑ Private 23 Depth to Water Table Al-9-:0-W Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No Zi --New Construction: Yes 2-'l o ❑ FHA/VA: Yes Q--No ❑ 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 erial... ,_ "s __-_-. No. of compartments_._,,,--._. .__. __Size-,W --Liquid depth...... ---------------,,r_apacity/,1Zer Disposal Field: Distance from nearest well FP ___Distance from foundation._/fir`----------Distance to nearest lot line-�a_ [ Number of lines---- ___ . , i Length of each line.__ rQ. --_-. �` Width .of trench (` - ------------- ---------------- Type _ . yp _ Depth of filter material___ _ Total length_./, ------------------------ Seepage -------------- ----�_-__ T e of filter mate _ - Seepage Pit: Distance to nearest�well----� �'_Distance m foyrndation....�,�_�.___.Distance to nearest lot line-:-J- -/.... Number of pits------4..__.-__-_Lining material__ : -�� _- ._._Size: Diameter__- ____.Depth;;?JwIlef !t___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------.-------------------- j ❑ _Size: Diameter----------------- ------Depth---------------------------------- _-===Liquid Capacity----------------------------gals. 0V Privy: Distance from nearest well------------_--------------------- --------------Distance from nearest building------------------------------------------ ------------------------------------------ ❑ Distance to nearest lot,Jine -------- ------------------------------------- ------ Remodeling and/or repairing (describe):------- ` � � 1 %'--- --r! 1.�..- -�-, 1�----------•-------------••----•-•---------•-------- ---------•---•---------------------•----------------- -------------------------- ---••----------------- �---•--------------------- ------------------•-----------•--•------ _---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ---------------------------------------------------------•--------------------------------------------------------------------------•--------------------------------------------------------- I hereby certify fheit I have prepared this application and that the work will be done in accordance with San Joaquin Count?f -ordinances, State la`ws,'and r hes and regulations of the San Joaquin Local Health District. (Signed)--------------�` = ------ By: -- ' 411 - 4 (Awrner. i,�er Contractor) B •------------- _-� ._ _ _(Title)--� (Plot plan, showing size of lot, location of system in anon +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- G�---------------- - -- —-------------------------------- DATE--------7------�-.�---- ./— -- - ------------ REVIEWEDBY------------------- ----------------- ------------------- - __ -------------------------------------------- DATE---------- ---------- ----------------- BUILDING PERMIT ISSUED---------------------------------------------- ------------------------------------. DATE--------------------------------- Alterations apd/or recommendations /.q. �7 ... y / C`.,- Zt -� i,--•�'. : F Lc J�r f� b ----- ------kk—�'� --- r `C l c L —� (�------- -------------------------------------------------------------- ----------------------- ----- -------.- •--••-----------------------------------------•----------------•-------------------------------------------------------•---------------•---------•----------------------------------------------------------------- -------------------•------------------------------------------------------------------------------ --•--------------------- ----•---•-------•--------------- -------- ---------- ------------- --------------•---- FINAL INSPECTION BY:- % / _________.. __--:-'.------ ------•---- Date------- - --------- ' ------ - - AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California _ Lodi,California Manteca,California Tracy,California