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FOR OFFICE USE:��rr'' �= °�� 6 ------------------4'`" ------ w p o APPLICATION FOR SANITATION PERMIT Permit No. ._f -__ �_.._. (Complete in Duplicate) Date issued This Permit Expires 1 Year From Date Issued Applicafiion 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-------,� --- - _----- e� ---------------------------------- Owner's Name--- --------- -------- ------------------ - - - - -------------------------------------- Phone------------------------------------ •--------------•----------------- ---------.._..--------- rr// F Address f -' Contractor's Name ------------------- Phone-'? �44 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: _f.-_- Number of bedrooms__ Number of baths .02. Lot size ------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table.!rd ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe%- Hardpan ❑ Previous Application Made: (If yes,date--------------------I INo ❑ New Construction: YesX No ❑ FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well;ho- ,_,.Distance from foundation-- Q---------Mate riai--- ------ e No. of compartments-.p2-------------------Size �,�.- _ -- - -----Liquid depth----- -----.----------Capacity..l ,OA-- ---- I Disposal Field: Distance from nearest well./44)1) --Distance from foundation_.--4___�-.__Disfance to nearest lot line._---------- Number of lines------X......... . ....... ...Depth of filter material.._Length of each line),04 '__9A.. Width of trench.-.�_y`---..---.---------- Type of filter material.=+-i_ - -- P /�-----/----Total length-----------•�-�--- ----------------- p Seepage Pit: Distance to nearest well from p�oundation_.�-O----_--.Distance to nearest lot line--_---�_-.-- le Number of pits---t�---------------Lieu material-;? ...Size: Diameter----.3-3-- --------Depth---------2--5- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_____._._.--------.---.----___-.--. , ❑ Size: Diameter--------------------- ----- „..,::.Depth ---------------------- - ---------------.-Liquid Capacity----------------------------gals. IPrivy: Distance from nearest well _______...-,-.-- ------------------------------Distance from nearest building.--.-.---__ ----------_-_-..._...._.-.-...� . ❑ Distance to nearest lot line- -------------------------------------------- --------------------------------------------------------------------------------------------- r� �S Remodeling and/or repairing (describe):-------Y- * -----------G3--- -- - - ----40V -------i ------------------------------------------ ------------------------------------4 -------------------------- -f--------- ------------------------------'-------------------------------------------------------------------------------- - ...1 I - ----=--- -------------------------------------------------- -------------------- ----------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f ordinances, S to laws, and rules and regulations of the n Joaquin Local Health District. 6 ----------------------------------- (Owner and/or Contractor) a'[Signed -- (Title]_ BY------------- - ...... ---- --- -- ----------- I (Plot plan, showing size of lot, location of system in relation to Ills, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY ' DATE------1-�'--,� 4f i� APPLICATION ACCEPTED BY----.. .- -c,rf ---------------------y----t/ ----------- �r REVIEWEDBY---------------------------------------- ------------------------- ----------------- ---------------------------------------- DATE =i ---- ----------------------,------ �' "4 BUILDING PERMIT ISSUED--------------------- - - ----- ------------------ -/ DATE == ---------- Alterations and/or recommendations:---- ---------- -----------------------------1 =`\ ------------------------ ---- ---------------------------------- r ------------------------------------------------------ --------------------------------------------------------- ,I .. " Date_ L �` 1�-��-- ----------------------------- FINAL INSPECTION BY:.-.A— . G- ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaietion Ave. 300.West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California TracY,California F.P.EO.