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:'FOR OFF CE USE: il APPLICATION FOR' SANITATION PERMIT Permit No. .C,�� _�`. (Complete in Duplicate) 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. 4. c � JOB ADDRESS AND LOCATION, Owner's Name C ------- ---- ------ ----------------- Phone t Address J"�'t-� S -`- _ --- ------------------ --- --------- -•-------•-• ------------------- Contractor's , -------- ----------------------------- - Contractor's Name - r.. ?/----- - ---- � �'-- "'cam--------------• Phone--/- �n-V•--- k Installation will serve: 'Residence E] Apartment House ❑ Commercial [ITrailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms J_._ Number of baths ---) Lot size ------ ff' ---------------------- Water Supply: Public system ❑ r Community system ❑ Private ] Depth to Water Table _ tt. Character of soil to a depth of 3 feet:-Sand ❑- Gravel E] Sandy Loam ❑ Ciay loam ® Clay ❑ Adobe ❑ Hardpan ❑ 5 f 1. Previous Application Made: (If yes,date....................) No F-1New Construction: Yes ElNo E] FHA/VA: Yes ElNo El 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 foundafion---- -.-_----.--.-.Material------------.---....-.._....__.-___----__--.-._. ❑ No. of compartments---------------------- ----Size------------------------•-------Liquid depth---------- ---- ----------Capacity..--------------------- p ,;.�1 Distance to nearest lot line----------------- X ..f ../. Dis oral Field: Dist ofol nese8rer well-��..-.._.Distance from foundation.. ............. �. e ;__ ._- Length ....Width offrench------7-:-/- ---------------- Type of filtdr material-_/ �L� e _.Depth of filter material-.ftf ............ length------. ................... Seepage Pit: Distan -to nearest well..,1P-.---.._ Distance fr foundation__ ---_Distance to nearest lot line___ ` Number its ti `�" p -- V �__ Lining materal_ Size: Diameter--- ._._. Depth s _..._____._.__.. Cesspool: Distance from nearest well----------------- from foundation___----------------Lining material_____ _ ___ ....._.______-._-.----._ El Size: Diameter----- ------------------- --------Depth-----------------------------I ---------------------Uquid Capacity---------------------------gals. \ Privy: Distance from nearest well--------------_----------------------------------Disfa`nce from nearest building------------------------ ---------------- ❑ Distance to nearest;lot line--.-.-�-'.------------- -- 1� ---------------------- ------------------------------------------------------------------- ----------------- Remodeling ------- ---------------------�- ---------{--- -------------M---.--------------- Remodelin9 and/or repairing (describe)........... -------------- ----- F --------------------------- --•------ ------------------ _---------------------•--------------------------------------------------------`-•-----------------•----------------------------------- ---------------------------- 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 rulessand re uiations of the S Joaquin Local Health District. (Signed)--------------------------- � — :.t/(f_ -.. � ------------ a Owne nd/ar Contractor) t \ r By:---------------------- " 1= ..-=r----------------------------- ---------------------(Title)----=---- y---------------- -' ------------ V (Plot plan, showing sine of lot, locetio of�em- in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---'-. y ' 6 ---------------------------- DATE-------- Z��--- 4�x I REVIEWED BY-------------------------------- ------ -- --------- - DATE t' BUILDING PERMIT .ISSUED------ -' -- --------------------- Alterations DATE------------------ ------------ ---------- --- --------- ' Alterations and/or recommendations:___.__ 'f 1.. _. -_ '�_. -- �- --------" ---'----• " = 6 � -------— ---- __:'_ z......... -------------- ------- ----=-_ -=_------------------------------------ -- '�� FINAL INSPECTION BY:................ .... ��= Date. w u r ' S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California