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FO OFFICE USE: fJ�-------------- - rig APPLICATION FOR SANITATION PERMIT Permit No. ___I___J..__..-_ .-_-_%�_i_ l __5---------------- _ (Complete in Duplicate) Date Issued _________ ----------------__.._..__ This Permit Expires 1 Year From Date Issued 17 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 A D LOCATION +S-� `�--d - ------------------------------ • ------------------------- - ------------ - - -- *� r ------------------------------ -------- -- Phone___W__ r_22 Owner's Name- ------ 7 ----------------_--------------------•...... --••-•-�/�� - ---------- Address •- `--------------------------------------------------------------------------- Contractor's Name______ J ________________ Phone -- Installation will serve: Residence -Apartment House p Commercial E] Trailer Court ❑ Motel El Other E] Number of living units: --/-- Number of bedrooms ---Y_ Number of baths _02-- Lot size ----------------- Water Supply: Public system ®Community system ElPrivate ❑ Depth to Water Tables Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ , Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 9 New Construction: Yes L!f leo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public /sse�wer is available within 200 feet.) �. Septic Tank: Distance from nearest weILL��'�Distance from foundation_f - ____._.Material.__P:�Lg... ............___---------___- �7 ---Size _f�_, .�_ _-- _Liquid depth--.----------------_Capacity- - --d�-- [� No. of compartments-4� r � Dis osal Field: Distance from near st well... e_Distance from foundafion__,C_-___.---------Distance to nearest lot Eine__ p f Number of lines_ -- Length of each Iinej4j__7/_&4_. _Q_-3&idth of french_---__-. .�-'`____ �/ Type of filter materialst_�.d.Gi --Depth of filter maferial__5� _401&M t`Total length------------ �-"�--.- r Seepage it: Distance to nearest .well-&VIVA'- __Distance from foundation------ ek_.._____.Distance to nearest lot line__d-______.__ Number of pits-----A ----.------Lining material_.5ije .�---.Size: 1]ia �r��- CLO-.---Dem+--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation---.--------.-------Lining material--------------------------------_____. N ❑ Size: Diameter----------------------------- -------Depth------------. ------------------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest weil=------------------------------------------------Distance from nearest building----------._.------`--------------------. ❑ Distance to nearest lot line------.. ---- ----------- ---------- --•-------------------------------------------------------------------------------------------- S` Remodelingand/or repairing (describe):-------------------------------- --------------------- -----------------•••----------------•---------------------------------------------------------- --------------------------------------------------------- y--------------•---------------------------------- ------------------------------------------------------------------------------------------------------ ------------- -------------------- ------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a ordinances, St laws, and rules and regulations of th an Joaquin Local Health District. (Signed)---------------------- --- - ---- ---- - -- ----------------- -- ------ --- - ------- ---,- ------ --- (Owner and/or Contractor) --- --- - - By:---------------------------- --------- ---------------- -------- (Title)---- -X_ -- f---------- - - -------------- (Plot -(Plot plan, showing size of lot, location of sys em in relation to wells, ildings, etc., can be placed on everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- - ------------------------------ DATE------ ,/�� 'r' --------------------- REVIEWEDBY------------------------------------ ------- --------------------- ------------ ----- -- DATE------------------------ ---------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- -- ----------------------- - DATE------ --- --------------- Alterations and/or recommendations:__- _. - )-------- -G-lr-�c�--�l--- ------- -_ ---- ---------- ------------------------------------------------------ , --------------------- ------------------------------- ------- -- ------------------- -------------------------------------- ---------- -------------------------------------------- ------ - ------ --------------------=-4-- FINAL INSPECTION BY:.-. ---------------- Date /.da—-------------- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasetlon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California