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ir;fzF(�R OFFICE USE: ---------- ------ ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No.,1fi�71Z-_-. ------------------ `------------------------------------- (Complete in Duplicate) - --- This Permit Expires 1 Year From Date Issued Data Issued 1G•_ 2 - �5 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 AND LOCATION--------- ,_-------._ / Z- /'` �+ / ` --------- ------------------------- ------------------ Owner's Name---------------/ t -!_ 1 -------- �l- rl� ----------------------------------------------- ---------- Phone- ------- Address------- '-`Address----__-_ _. / ,gyp ��?W_ --_--------- `!'�� ------------------•-----------------------•--...------------------------------------- �o .�Q I -------- Contractor's Name----- ---- 1`j�-.- f_ -1.-5 _: E-- Phone - - Installation will serve: Residence /B partment House ❑ Commercial E] Trailer Court El Motel E] Other El Number of living units: ---t!-- Number of bedrooms -- Number of baths --- --- Lot•size ------ _x--/_ - __ _- ----------------- Water Supply: Public system M__1C1_0_mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: •Sand ❑ Gravel [!],k Sandy Loam ❑ Clay Loam E9--'Clay ❑ Adobe ❑ Hardpan ❑ :Previous Application Made: (If yes,date-----------___ -.l No yNew Construction: Yes ❑ No [3— FHA/VA: Yes ❑ No El-- TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation---------------.... Material_---_____.-.-.--_-._.--------._: . . ❑ No. of compartments------------ ----------- -Size--------------------------------Liquid depth---- ------------- ------ Capacity----------------------- Dis osal iefd: Distance from nearest well.._.T__---...... Distance from founda:tion--- Z�<-----Distance to nearest lot line----------------- Number of lines----- -- ---------- - Length of each line-- 1—-----------------Width of french..-_-��f---------------.-- T e of filter ma Depth- J F ------------ Yp /��f`,�C -Depth of filter material- ' -----------_Tofial lengt -- d----------- `.---- - -_--/ $espagP/Pit: 4 Distance to nearest well.-.SGB-�-.-___Distance fro foundation_-fp............Distance tonearest lot sine----i.-f --- ❑ rNumber of pits-* -------------Lining material_-- V Size: biameter------- `~ --`Depth__.-. - ---.-.__..--- Cesspool: Distance from n crest well----------------Distance from founc%f10nI:4-----___.____--.Linin material------_-----------_-.__---..--_.- -_ ❑ Size: Diameter..-__i------------- - 1� ' g t ---# -------- Depth ---------- I----I-------------Liquid Capacity------ -------------gals. 4 Privy: Distance from nearest well-----i----------------------------------------[Distance from nearest builds;ng----------------------------- - N ---------- L ❑ Distance to nearest lot line__~..- "�___.. } Remodeling and/or repairing (describe):____-_ _--1 _ r_ .�---- . �� -- -------------------- --•---------------------------------------•-----------:-----=------------------------------------------------------------ --------------------------------------------------------------- " --------------------------------------------------------------------- ------------------------------------ ------------------------ -- -------------------------- -------------------------------------------- -------------------------------------------------------------- --------------- 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,,an- rules and regulations of the an Joaquin Local Health,District. (Signed)------------------- ------- -------- ------ -------- r`'=--- ------------------ ----------------( ner and/or Contractor) E `, By:-----'------------•----- ;'� '4----= ,!`•-- - --------------------------------------- ---- - r ---------------{Title)------s------—"�' - ---/---------------- ---------------- ..- .- t/ ,Er� -- (Plot plan, showing size of lot,,location of s s em in relation to wells buildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..._.... ------ o%61- = � DATE �� z�� -REVIEWED BY --------------------------------L--------------------I------------------------------- ----------------- --- DATE ----------------------------------- G BUILDING PERMIT ISSUED -- �} DATE .Alterations and/or -G'- - - ---------- --------------------------------------------- ------------------------- ------------------------- - ----------------------------- ----------------------------------------------------------------------------- ------------------------------------------------- FINAL INSPECTION BY:.. r` ----- ------------------------ Date �Q SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes!9th Street Stockton,California Lodi,California Manteca,California Tracy,California