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FOR. OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ '�. ------ - --- - ---- ------------------------------------ (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 here' described. This T>I_ica io� is made in compliance with County Ordinance No. 549. - e Mh RO JOB ADDRESS AND LOCATION ' . StlrJ C - ------------ ` -T - --- Owner's Name------------Clo-F—----------i ----------- ------------------------------------------'Pone__T. L ,3, r------------ - -- lt. �Address---`------- 1� --- _ --------------- ------------------------- + Contractor's NameR- - �.L- ----- --------------- Phone..------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __]_timber of bedrooms --umber of baths __[-___ Lot size ___/ Q__xZ.� ----------------------Water Supply: Public system mmunity syst ❑ Private ❑ Depth to Water Table IQ_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ San y Loam ❑ Clay Loam F] Clay E] Adobe 1-1Hardpan ❑ Previous Application Made: (If yes,date--....._............I No ew Construction: Yes <❑ FHA/VA: Yes E;I�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) Septic ;af1k: Distance from nearest well_-C!_. Distance from foundation----I42--------Material--_ QNC_iE [� No. of com artments__.__ .q_X Li uid de th_- �____Ca z,----Capacity 0® p � Size / G p. p Y Cn Disposal Field: Distance from nearest well.Cr.W_Distance from foundation../49----------Distance to nearest lot line--5^-_- _I Number of lines---------- --- --._-_---Length of each line---_,QQ__`_ Width of trench-_ - _ ie Type of filter material--_ G1 __Depth of filter material-.-._-_l Totaf length--------------A7_G-_-___-_---_-__ Seepage Pit: Distance to nearest well------- --------------Distance from foundation------------........Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_-.----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material------------------------------------- 0 Size: Diameter--------------------------------------Depth--------------------------------- - ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we]-----------------------------------.--- ---Distance from nearest building_L_.__-__--__________-_____-_-_----. ❑ Distance to nearest iot line--------------------------------------------- ------------------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe-__-AP5s;_L33/_�f--�_--Pr--____CL7T_`__-_---_6� .R 5____:_t!Y____.TI` -------- 470tk_A_rr��*----------�k-R,-- ----------------------------------------------------------------- ----------------------- - -------------------•---------------------------------------- ---------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------- ----------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereb ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , Stara>-<Pd rules and gulations of the San Joaquin Local Health District. (Signed))--- --- --- -------- ---------- -------------------------------------------------- --------------------------------(Owner and/or Contractor) 13 , r�.SQ N ------------------=-- `*� -----------(rale) = _ -_= - _ (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.-----Fit- -7-4- BY---- -------------------- ------------------- ----- ------------------------------------ ------- ----------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations------- ----------------------------------------------------------------------------------------------------•------------------------------------------------ --------------•------------------------------------------------ -------- ---------------------------------------------- ---------------- ----- a ------------------------------------------------------------------- -------- ------ ---- ------- -------- ---------------- ------------ -- ------20?------ - - 11 r��r --- F1NA1_ INSPECTI •------ -- - - -��-�- -------- - Date -�--�--�u----�U.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R.c o.