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UFFICE USE: ----------- -- _________ ______..-----..---.--.----.-_- 11, APPLICATION"FO SANITATION PERMIT Permit No. /_ [--_9__... ----------- -------------------- ----- (Complete in Duplicate) t� Date Issued -------- ------------------ This Permit Ex fres i Year From Date Issued 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,--�� ---��' s. ---=``--•---------------------------------------------------------------...----------------------------------------- Owner's Name---A—etom--------- l ------------ -------------------------------------- --------------------------------- ---- ----- Phone__------------------------------ Address. hone.---•------------------------------ Address. `;---'�--- --- ---- - --------------------------------------------------------------------------------------------------------------------------- Contractor's Name -- `S -----------------------------------•--------•-------•--------------. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _--./-- Number of bedrooms -- 7+5'^X -OQ--------------------------------- a� Number of baths --_�-_ Lot size ----------------f.-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -4p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &_T�iardpan ❑ Previous Application Made: (If yes,date..rT7_ .) No ❑ New Construction-. Yes ❑ No >�FHA/VA: YesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank, Distance from nearest well----- --------Distance from foundation--------------------Material---------------------------------_--------------- No. of compartments--------------------------Size--------------------------------Liquid dep? h---------- -- - -------- Capacity---------------------- . Disa�m Distance from nearest well.... ........Distance from foundation_-,0..__--___.Distance to nearest lot line-.5 I----- Number of lines--------f 9 ----Width of trench-- - • �1 ii ��-----------------Len th of each line- --7�-------� - - ----�y:-------------------- � Type of filter material--f L-_e 4f�_--.._--Depth of filter material--hr---`---------- length------A�----------------------- � Seepage Pit: Distance to nearest well-----...-- Distane�om foundation-Jiv-r------.--Distance to nearest IQt Iii s�-. -_.. Number of pits---- ----------------Linin material---'--�4_-�--.--.Size: Diameter._.---.--. vzJ Lining � ..Depth-- ----------------------------- Cesspool: --------------Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----..-----_-----.-.----.---__.-.--.. ❑ Size: Diameter.------ --- - ------.Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------- ------Distance from nearest building----------._-__-----•-----------...-.--.-. 0 ❑ Distance to nearest lot line----------------------------- ---------------------------------------------------------------------------------- '.---------- --------------- �. l _ t R lin and/or epairing {d cribe):- C fT ]c5 -'�- �'�"P_'r-..f-----`�.� ' - `-- -------`------l---------- ------ ------ ---------- - ------- ------ _ ---�---------------------- - --- -1 ----- ------------------------------------ ,3= •d- " s� _ y - �- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rules and regulations of the San Joaquin Local Health District. (Signed)---- ------- -�'~ - - (Owner and/or Contractor) B (Title)- (Piot plan, showing size of lot, location-.of system in relation to wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------d/Z---------------- ---------------- DATE------- ---------------------------------- REVIEWEDBY- --------------------------------------- - ------------------------------------------------------• DATE----------- -- -------- BUILDINGPERMIT ISSUED--------------------------------------------------------------–----------------------------------- • DATE----------------------------------------------------------- Altera ions and/or recommendations------- - ---- --- ------------ -- ------------------------------------------------••-----------------••--------------------------------- - ----- ------------------------------- --=- -- --- - - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ - --- -------------------------------------------------------------------- --------------------------------------------------------- ------------- ------------------------------------- FINAL INSPECTION BY:.................eT,11�------- - - -------- - -- ------- Date---- ---4� -------------------------------------- SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t " Lodi,California Manteca,California Tracy,California F.P.r,U,