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FOR OFFICE USE: w� ------------- ------- ---------------- --------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No./,V a....... - i' - -- (Complete in'Dup}icata) Date Issued ✓-------- -------- ------------ _ ate Issued r This Permit Expires 1 Year From Application is herebyrrlade 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 LO ATION------------ _ .WSJ 1Z -------------------------------------•- -------------------------------------.._. Owner's Name --- -- > _• - -------------------- ------- �,.. Address-------------------------- .. li. _ .� Contractor's Name---- / 1 ,f -ter -- ---------------------------------------------- Phone__ t` ,17 Installation will serve: Residence s- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms ___ rr� Number of baths _ILot size _ _X11_ 'J�-42n---------------------_---- Water Supp€ • Public sysferACq Community$ i k stem ❑ Private F []Depth to Water Table _ ft. i Character ,of soil to a depth o'f 32@et:Sand ❑ Gravel SanLoam E] Cl y Loam ©!Clay E] Adobe❑ Hardpan El Previous Application Made: (If yes,date--------_ ,__*_ __-1 ,,No [2` New Construction: EYes ❑ No ❑y FHA,/,YA: Yes ❑ No E_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available•wtthin,200 feet.)% [ meta#�+►� Septic Tank: DistancAfrom nearest well-----------------Distance from foundation------------------- Material___ ------------------------------------- ❑ No. oKompartments--------------------------Size-----------------------:--------Liquid depth__.---------_--- pacit Capacity yY { Disposal Field: Distance from nearest well_J�_.._..._Distance from foundation_ _ // �� Distance to nearest lot line__ ------------- Number of lines-------- 7!!F7_ le.___-___-__Length�of each line----- of trench___-- "---.----_-- Type of filter material__` 1 'c j��__Del:>h of filter material/ _`°--_------Total length-------- --------------------- is _________________ Seepage.Pit: Distance to nearest well �?_z bistan o. ndation__r�u� _f_._.Distance to nearest lot- line_��_�. ©� Number of pits-------�-.-_''Lining m�ateri I__ ' � ----.Size: Dia ter-_- Depth_-- w-� __� -=------ ----- Tvt Cesspool: Distance from nearest,,well-------------.e©ista m foundation------------------__Lining material_____.-____.__.3__.._-_-_..__.______ ❑ Size: Diameter --------------------- -'r+�---Depth------------------------------------ - -------------Liquid Cap cil, gals. Privy: Distance from nearest we/ll� __________________.._______.___________Distance from nearest building-_ ______._____z__r__._____- } ❑ Distance to nearest lot lifie._._ -----------__---_ ----------�_._ /_1------------------ 4 + r Remodeling and/or repairing �escrib�. - ---_ -- - �-------------------�',rT//1�-�__.s.,�,��`iC'�,1.f------------------------------ ------------------------------------------------------ -------- ---••--------------------==------------------ ------------------ ---------------- ---------------------------------------------------------------------------- , . 1 ---------------------------------------------------------------------- --------- I hereby certify that [,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. (Signed)-------------------- ----x -=------------------------------- ---------------------(.Owner and/or;!Contractor) � , By: # ------ _ [Title) . - (Plot plan, showing size f lot, location system in to wells, buildings, etc., can be placed on reverse side). -- t FOR DEPARTMENT USE ONLY APPLICATION ACCEFiTED 13Yf --- ---------------------------------------------------------- DATE ,-�� 5�-------------- REVIEWED BY------------ =- -------------f------------- - ---- ------- ------- ------ DATE------- BUILDING PERMIT ISSUED ----- - ----- ----- --- DATE DAT1=------------- Alterations and/or recommendations:.__ ,_ -.._ /� ' ;��`------------------------------------------------------- - ------------- --------------- ------------------------------------ --------------------------------------------------------------- ----------------------------------------------------•--------------------•--- ' ---------------- - -• .----- [ [ -----------------------------------------------------__= ------------------------------------------------- ---------------------------•--•---------------------•---------------------------------------- .....................................................................................................r_...___-_-.________.____---------------------.___�__�...1^_____.--_--.-.. _ //, FINAL INSPECTION B _ -- C Date---------------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. �1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi;California Manteca,California Tracy,California F.P.0 O.