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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No, .6................... � (Complete in Duplicate) c Date Issued --------------------------------------------------------- j This Permit Expires 1 Year From Date Issued : Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstall the work herein described. This application is made in compliance with County Ordinance No;1549. JOB ADDRESS AND LOC TION------ ✓ --------------------- ..�� U IiUJOo �lS,o�0 . ' - ------------------------------------- ------------------------------------------------ .., Owner's Name ------------ ------ ------------------ Address - � - fN 1�s�3 �} 0 �< Address------ v <-r edG rr ----------------- - Contractor's Nam 4�-�-- ---------•---.-_-------------------------- Phone Installation will serve-..Residence [K Apartment-House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ r Number of living units: _______ Number of:-bedrooms -------- Number of baths ________ Lot size -----________________D__._________.______________________-- Water Supply" Public system ❑ Community system ❑,Private K Depth to Water Table -------- ft. Charec+er_of soil to a depth of 3 feet: Sa d,• Gravel ❑ I Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date_ *.... ....-_)No ❑ New Construction: Yes ❑_..No ❑ FHA/VA: Ye s:❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:' • fl � l: t {No septic tank or cesspool permitted if public sewer is available within 200 feet.)'' Septic Tank: C4�tance from nearest well_________________Distance from foundation_.-------------- Material...__ 6 � --.----_- com artments...________._ - t-C' __.__._.Size______________ _____ __i _rLi uid de th___. �.. ___ __ Ca acit p r 1. �. q R P Y ; Disposal Field: P____...._Distance from foundation _ ___ __ •' ; � Q Y ante from near t well � ,�___.Distan'"e +a nearest lot line______________. �y }, ice,/STS; tuber of line�e Length of each line_______ Q ------ Type of filter material_ Depth of filter materia`_ _Y_ Total`'length---� .-- � __-_-________ Seepage Pit: Distance to nearest well-------------______-�--Di3tance'fr•orrs'foundation--------------- Distance•+o nearest.ldt line______._________ Number of pifs-------------- ------_Linin Lining,material Diameter______._._..___0.90e thl---------------/ ._ .r. t i? _ C----------- ro 9' r $ 'E inin'g�mate'ria------------------------------------- 0 �>� � Cesspool: Distance from nearest well-----------------Distance from foundation.____.- __._:-____.-___________-.____________ Size:;Dtameier'�±--`.----'3_:-i+ _n_.__s.x,_0.De th---=-------'`-------------�-- -.----------_-,Liquid-Capacity- ❑ als. Privy: Distance from nearest well------- ---------------------------------------- Distance cJfrom newest building-------------------------------- [] Distance to nearest lot line...___'________________- "£--------- - ------------ f 41 Remodeling andCrrepa�lriing escribe] __________ -------- _eG x l _ -- g-------, 'e 4 b. ----------------------------------------------------------- -------------------------'-'--___--- -----------'----_____ -----;------'------- f --------- ------------------ I hereby certify that I have prepared.this application and that f9 work will be done in accordance with;San Joaquin County ordinances, State la s, d rules and reg tions of the San Joaquin Local Health District. 4(Signed) -Y ----- 7-'-'---._._._.{Owner and/or Contractor) BY = `";'`_`'== = , ----; (Title),1 (Plot plan, showing size of lot, location of.'sys+em in relation to(wells, buildings, etc., can Abe placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... ------------------ ------------------- DATE-------- REVIEWEDBY---------------------------------------- ---- -- --- ---------------------- - ------- - ------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- `------------------------------- DANE--------------------------------- Alterations -------------------- - -------Alterations and/or recommendations------- -------- - --------- ------ ------ ----------------------------------------------------------------------------------------`-----------•---------- ---------------- ------------------------------------------------------, --------------------------------------------------------------------...----------------------- -------------- ---------------------------- 4 FINAL INSPECTION BY:. ZX -- - -------- --- _._.� 3 /. Date --- - SAN JOAQ IN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C❑.