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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - -• -•• ------.---- A,-. 10 (Complete in Duplicate) Date Issued A/J--GC --- _.- This Permit Expires 1 Year From Date Issued ---- -Applicais 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. fQ_P --------------- --------------------------------------------P--h--o--n--e-----�---- ----------------------------- JOB ----•-----------------------JOB ADDRESS AND LOCATION------- ---------------- ----- -- aJr------- Owner's Owner s Name--------------- ---•------ 9--• e--G�---------------------- - ------------------------------------ LAddresses- i_6-.-------- ------ S"/ -----_--------------------------------------------------------------------------------------•--------`-•--------- -- -V,6--?-f -- Phone_' Contractor's Name---- Installation will serve: Residence Apartment House [I Commercial El Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-__ Number of bedrooms ---5-- Number of baths ---:�- Lot size -- --x- • -7�---�--------•----------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [y—Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date---------_---------) No [5' New Construction: Yes ❑ No [a— FHA/VA: Yes ❑ No [�J— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well--..__-..____---Distance from foundation--------------------Material------------------------------------------------- 0 No. of compartments-------------------------Size------------------- ------------Liquid depth----------------- -------.Capacity------ -- Disposal Field: Distance from nearest well___---=-= -Distance from foundation__3/d�-- .-.-Distance to nearest lot line%____.._ W k ❑� Number of lines-------1___-_--- ------Length of each line----C .cry - -----Width of trench---.:��--- - -----/------ 6 1 Type of filter material._- ' d. C--Depth of filter material./,gto----------Total length___-�- - ------------- MA5^ Distanc to earest lot linea..-----_- Seepage Pit: Distance to nearest well _rr--_____-Distance fr foundation_ _______________. _ .11 Number of pits...._______________Lining material__ � _-:.Size: Diameter._ .- epth-- arZS ------------- Cesspp000l: Distance from nearest well-----------------Distance from foundation---_---------------Lining material-----------------------------------I— E] a Size: Diameter--------------------------------------Depth--------------------------------------------- -----Liquid Capacity----------------------------gas. O _Distance from nearest building ------------- Privy: Distance from nearest well--------- - ------ g---------------- ❑ Distance to nearest lot line-- -------- - ------------------------------- - Remodeling and/or repairing (describe):--------- �� --�- -- ----- Get`/ i G eqm/---------------------- -- -----------------------------•------------------------- ------------------------------------------------ ------------------------------------------------------------------------ ------------ - ----- - ------------------------------------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules and regulations of�the S--an Joaquin Local Health District. �s ��__/Y�---------------------- ---------------------------------------- Ow rand/or Contractor] (Signed)-------------------- --- -��-- ----------��---- By:------------------- (Title)-- --'------------ ------------ --------- (Plot plan, showing size of lot, location system in relation to welds, buildings, etc., can be placed on reverse side). r FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY ------ ------- --- DATE �� -------------- APPLICATION ACCEPTED BY - ------ D ATE- i BUILDING PERMIT ISSUED_ DATE----------------------------- ------------------------------- --------- Alterations and/or recommendations: W��------------------- - - --------- -- l. -------------------------------- ---------•--------- -----•--- -------------------------------- - - ------- -- FINAL INSPECTION BY:-._._.- , � � Date----- /�/ ------------- ---------------------------- �. SAN JOAQUEN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street205 West 91h Street 1 Stockton,California Lodi,California Manteca,California Tracy,California