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7,_.._-_.__-_. APPLICATION FOR SANITATION PERMIT Permit No. ___1...`!............. u Itcate �° f 6 - (Complete in D ) P Date Issued •--- � ......_------------------------------------ _____________ 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 compliance with County Ordinance No. 549. JOB ADDRESS AND L ATI N_ ____... -7--!-____ ---- '` -----------------�—� rA /-� �y�``� -------------------------------------- Owner's Name t ------------ Phone_c./-----� / '".. -- Address :... 1 -------- ------ ----•--------•-------------------- -----------------------•----•----------- Contractor's Name--- " --------- = -------------- - ----- Phone.--................................... Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel q Other ❑ Number of living units: ---�__ Number of bedrooms ____ 14umber of baths ---4- Lot size ___________________ Water Supply: Public system U2rCommunity,system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E?-iflay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date/ //_Y_1_:7) No ❑ New Construction: Yes ❑ No ♦ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermiff6d.if public sewer is-available within 200 feet.) Septic Tank: ,rt- Distance from nearest well-----------------Distance from foundation--------------------Material------------------------.__-----------_--_______- E16K No. of comparfinenfs. ---"-------------------Size--------------------------------Liquid depth-------------- -----------Capacity--------_------------ Disposal __-----_-----------Disposal Fie Distance from nearest well-` stance from foundation------ to nearest lot line._________ Number of lines_____________ _ Length of each lin- Z_ ----------- of trench. -----Zj______--__-_-_____-_ �v I -- _ Type of filter material__:--------------------._Depth of filter material----------------_______Total1 length________________._________________-____ Seepa Pit: Distance to nearest well._:77�::6 _4-00istance from foundation----Z".0--------Distance to nearest lot line__-__'�/_._ Number of pits............j-------Lining material-___ Size: Diameter--_ _��____- Depth_____.-�{-_�-> Cesspool: Distance from nearest .well--------�-_,._=_Disfance from`foundation____________________Lining material----__-________. ❑ 5ize: Diameter---------------------------------- -Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well------------------------------------_------------Distance from nearest building---------- ___--------_-__-_- ❑ �. Distance to nearest lot line - -- --- - ---- --------------- - - ----- ----------------------------- ------------------------------------------------------ Remodeling and/or repairing (describe):-----------µ ------------- - tn. i -----------•--------------------------------------------------------------------------- --------------------------------------------------------------------- ---------------------------------------------------------- l a ------------------------------------`-----------------•--------------------o---------------------------------------------------------------------------------------------------------••------ --- °=--s-.-' �E I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State +�fflaws, and rules and regulations of the San Joaquin Local Health District. ry„/�Ht ---- i Si nedW FD�'LT" ---------- ----------------------------------------------------------•-----------------(Owner and/or Contractor) ----' (Title)---------------------------------- (Plot(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 f APPLICATION ACCEPTED BY--- f---------------------------=------ DATE-------- ;��-`- ------------------ ------------ REVIEWED ----------------- REVIEWED BY-------------------------- =-- ------ DATE-------------------•------------------ •--- BUILDING PERMIT ISSUED-------------------------------------- PATE------- --------- --------------- ---- Alterations an /or recommendations:- 4 �� S - --- ------------------ Alterations -------------- --- --- - ----------- �£. G_ `--�-- /�� ------------ - — - ice` '~----t. =�ti -------r. C `=----- ----------- / ---- __ �----� ,�� - -------- - �-,-✓LC �- - -----' ---- - p �- .- -ems / c, ________________________________ !_..__.._._.______-__a.______/'J' _._.- , �__ FINAL INSPECTION BY: = e� f I ----- -------------------------- Date. f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California