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FOR OFFICE USE: ---------------------- ------ -------------------- APPLICATION FOR SANITATION PERMIT Permit No. --•;�_�=�...�� ----------------- 1— -- --------------------------- (Complete in Duplicate) ---___----_______._._.___ __ ------ - This Permit Expires 1 Year From Date Issued 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 A LO ATIO ---- _----- Owner's Name- �'1 <d1 -fir --- Phone------------------------------------ Address-------------- ----- ----- -------------------- ,�c�Cr Address -------- -- -- ----- --------- Contractor's Name . '' -- 0-,./ - te 1- _ ---- ��7^l�t l. Phone `�fi = Installation will serve: Residence rApartment House [-] Commercial ❑ Trailer eumf Motel ❑ Other El Number of living units: __L___ Number of bedrooms ----/_ Number of baths ---/_ Lot size ----- f- ------___________________ 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 ❑ Clay Loam ❑ Clay ❑ Adobe EKHardpan ❑ Previous Application Made: (If yes,date._------ _----- _ ) No New Construction: Yes [9-14o ❑ FMA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tpnk: Distance from nearest well-_5Z _ .Distance from foundation---- No. oundation---No. of compartments_._ _ __2_.___--F__t_Size_-_ , ------ -----Liquid depth__.- _/------------- Capacity_.gG� �___ Ilk Disposal Field: Distance from nearest well_,5Z___.__Distance from foundation_//_._______Distance to nearest lot line--------I--_---__- [�K Number of lines---------l_---- _.___Length of each line_-___fz':._`-------------Width of trench____ .Sf�..___.............. Type of filter material_ -/;3F �`' Depth of filter material____ _��_-.Total length----------- `--___ _.-_.._. Seepage. Pit: Distance to nearest well/ 11-1-_ _ -__Distance m foundation__�__�_..____.Distance to nearest lot line__.___/._. Number of pits____ .___.-_ __Lining material___</i'_,___--Size: Diameter___..:a.�"--------Depth----- .>.`_______________- Cesspool: Distance from nearest well-----------------Distance from foundation-----------------__Lining material---- Size: Diameter---- --------------- ---------------Depth-------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building____.____________----.__________._. ❑ Distance to nearest lot line --------------- ------- ------------------------� -- Remodeling and/or repairing (describe):-- � ;` ----------------------------- ------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------•----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St`j laws,,and rules and regu tions of the San J quin Local Health District. V.., (Signed)__.__. _ - --� wrier and/or Contract e or) BY:--------------------`------------------------------------- - --'f•.=�'- u-',��. Title (Plot plan, showing size of lot, location of sys+eni in relation +o wells, buildirfas etc., can be paced on reverse side). DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY------- - ----------------------------------_------------------ DATE- --------- 7 / REVIEWED BY---------------------- - - DATE-------- ------ - - - --- ----- ----------------------------- -- ------------------------------------- BUILDINGPERMIT ISSUED------ ------------------------------------- ------------------------------------------------.-- DATE-------------------------------------- - -- Alterations and/or recommendations: /rC�/¢_�._-_ -- _!�_ey.F,_ _.__.. ,, �... . ......... -__. _.-- ' —L --------------------- ----------- --. --..._._ __ ---------------------- --------------- _ (_ _ r�__- . ._ . ___ `!.ba__. z'Oha f__ � -------• /( .......14-------- --------- ------ --------------------------- ------------- -- -------------------------- ------ -- --------------- ------------- ------------------------------------------------------------------------------------------------ FINAL - - FINAL INSPECTION BY: - Date. ✓�-y ` ' ------------- ------------------------------------ S N OA IN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.