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lAX OFFICE USE: u --------- ------------- ------------ ------__--- ------ APPLICATION FOR SANITATION PERMIT Permit No. ./� ------------------------------------- --------- (Complete in Duplicate) ------------ ----- ---- This Permit Expires 1 Year From Date Issued Date Issued -------- Application -____--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 wifi County Ordinance No. 549. JOB ADDRESS AND LOCATION_'__.6?- -, -- - --9—->&"0.1114410-�,� =--- Owner's Name-----------_ o7,_.P7--•--••--•- R -------------------------------------------------------------------------------- "6 r Address---------- -UQ 7 �- J Contractor's Name �-+ - - lnstallation will serve: Residence �partment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __- Number of bedrooms ----/_ Number of baths __/__ Lot size ----- • ! -_t— -- ------------- Water Supply: Public system ❑ Communitysystem '� y ❑ Private epth to Water Table-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am ❑ Clay Loam ❑ C Adobeardpan ❑ Previous Application Made: If es,- ----------------- ---I Y I No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.)y Septic Ta Distance from.nearest well-4 __1-------Distance from foundation- Material_ -- a_ �".1-- ; k- ----------------- _ No. of compartments______..__---------Size---- -uid Disposa l� -------Ca acit Y----f�--------earest well...o Distance from foundation _. � --_:- .Distance to nearest lot line_____ --- . Number of lines-l----------�-_-------__---- --Length of each line-------�lb_l_____-----Width of trench__'--, %__ Type of filter material_-- .j_y-> ---Depth of filter material_.---- -�%t---.Total length_____--- ,Q.-l------------------ rte.,..• _ ��-----�...,�.�..• ,.r_—_.� - Seepage Pit: Distance to nearest well ------- --------Distance from foundation_-_--__._ _____.Distance to nearest lot line----------------_ ❑ Number of pits-.-'------------------Lining material-----------------------Size: Diameter----------------------_Depth........... ---__--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter- �1------------ ----- -------- -Depfih------------------------------ ------ ----------Liquid Capacity----------------------------gals. � Privy: Distance from nearest well__--_____..____ ---------Distance from nearest buildingI ❑ Distance to nearest lot line-------- Remodeling - --- -Remodeiing and/or repairing (describe):____-..____ r ----------•-------•------------------------------------------ -------------•------------------------------------------------------ -------------------- ------------------------------------------------------------- - --- ------------ ------------- -----------------------------------------------------•----------------------------------•----------------------------------------------------- ---------------------- I hereby certify that I have prepared fh��--is plication and That the work wifl_be done in accordance with San Joaquin County ordinances, Stat ws, and r and'regulations of the San Joaquin Locel Healfh District. x (Signed)--------- - J / -(Owner and/or Contractor) By:--------- ----------•-- - ----�1l�%� -------- ------------- - (I if (� of plan, s owing si f lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). w ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - .----- -------------- DATE_ : IEWED BY-------------------------------- DATE------- BUILDING PERMIT ISSUED --4--------------- '.- ------------------ DATE ------------------------------------------ ---------------------------- Alterations and/or recommendations:_--_-__.__,�_1�,.,.-_--__-„_=_.. _-- ----- --------- ------------ - ----------- -------------------------- ------------------------------------------------ - ---- - --------------- --------------- -- --- -------..-.--- I ------------------------------- ------------------------------- --- - - i FINAL INSPECTION BY:- `- ------------ - Date...... _S _ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205-West 91h-Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C q.