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FOR OFFICE USE: _ ____ ___ _______ _ __ APPLICATION FOR SANITATION PERMIT Permit No. 1� ___... ---------- ------- ----------------- -- ---- -------- (Complete in Duplicate) — 7 ........... 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. hn JOB ADDRESS A __-- LOCATION----_�0® -r- - -tD p? /Oi✓ G ' lr_(ATA Owner's Name------ Q-- --------- f!1,S / -------------- - )0_D .F- ----------- -------- - Phone-----•---------- -------------- -- Address.. �D.. -•-------- �-�- - ------'�/�/o.!� ' ---- --------------- Contractor's Name------C,14CTl L_�------------------ -- ----------------------------------- ------------ ------------------------- Phone----------------------------------- - Installation will serve: ResidenceApartment House [:] Commercial E] Trailer Court L] Motel L] Other ❑ I Number of living units. ........ Number of bedrooms _ 15- } __ Number of baths _ __._. Lot size ___ .. ___��_.�________________________________ Water Supply: Public system ❑ Community system ❑ Private ;Z Depth to Water Table _f5__ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------............j No New Construction: Yes ❑ No 2;'-FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION-AND SPECIFICATIONS: - - - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frorrm-nearest well__S-----_-Distance from foundation......1_d--------Material------ --------------- --------------------_-__. tST1 AfG,No. of°ComJ artments--------------------- ----Size--------------------------------Liquid depth---- - - - Capacity. Disposal Field: Distance from nearest well--_ ----Distance from foundation---10----------Distance to nearest lot line_____5____ F�'JI IM Number of lines-_____ _.._____ ________________Length of each line------- Q____-_`�._.-.Width of trench---.-/.�/-{I- _.___ t �} �}D D, Type of filter material____R-� Depth of filter material__.._ _____._.._Total length________________ ____T-�--_.____.__ Seepage Pit: Distance to nearest.well-._- -__Distance from foundation_------------------Distance to nearest lot line--.----:..--.-.-- ❑ Number of pits.......?--------------Lining material---------------------- Size: Diameter-------................Depth-------------------------------._ 4 Cesspool: Distance from nearest well-----------------Distance from foundation.------------------.Lining material------------------------------------- Q ❑ am Size: Dieter----- ---- ------------ ----- ----Depth----------------------�- — - - --------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well----- -------------------------------------------Distance from nearest building------------._.__.--._----.----_-.._------ ❑ Distance to nearest lot line... -------------- --------------------------------------------------------------------- h 9 Remodeling and/or repairing (describe):--------X17.._.- _-- jam_ R -------- -R-�--_-_A._-A---_--._-POSSI--)3-IL(7-y--- Itli( = Y�l� nt 14 R Fc�Uk ----`------ --------- ---------------------------------- -------------- ------------- ---------------------- ----------------="---------------------------------------------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --- ------ -------- ---- - 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, anyrulle�' and regulations of the San Joaquin Local Health District. e(Signed) ' --------- By: r � p (Owner and/or Contractor) e r .'.:,-- - . --------------- Title BY:----------------------------- ---------- { ) ------------------------------------------------- (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 APPLICATION ACCEPTED BY --------------------------------------------------- DATE J�'�- S`- S- I REVIEWEDBY------------------------------- -- ----------------------------- ----- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED-------------- f .: ^~..�- - "' DATE ------ - _- ------------------------ - - ------ --------------------- ------------------------ Alterations and/or recommendations:_ ----- -------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ---------- ------------------------------------ ----- ------------------------ ---------------•------------------------------------------------------------------------------------------------------ i ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ - ---•---------------- ------- ------ -------------- -- -------------- = - - ---- - ----------------------------------------------------------------------------- ------------------------ -------------------------------------------- ---------- -- ------ -- -- ----- -- ----- - - ----------------------------------------------------------------------------------- ----------------------- ' FINAL INSPECT Date ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 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.r.O. , a