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FOR OFFICE USE: - --------------------- ---------------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit-'No. .s2_A4�?-fl ------------------- -- - -- --- ----- -- ------------ (Complete in Duplicate) Date Issued ---------------------_-----------------------_.-.-_ --- ___ This Permit Expires } 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 compliant with County Ordinance No. 549. IZ¢3 3X-77 JOBDDRESS AND LOCATION _ !✓_ iG - --v %'l� YAG -�,.._I _--___�Nr,�.J.�- c�C Owner's Na, e�y �— -- --_------------- -- -------- ------- --- ------------- ---- --------- Phone------------------------------------ Address-----W�----- ....-.y:... -- --..... J F Contractor's Name------- - ----- --- ----•------- -----------------------= ------------------------------------------ Phone----_------------------ Installation will serve: Residence E] Ap rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !v"' Number of living units: -------- Number of bedrooms -------- Number of baths __ Lot size _______._.._.______. _._ ----------------------------- Water Supply: Public system E] Community system [) Private Depth to Water Table -------- 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-----_----- ----- _) No .❑. New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ®® ', TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank-at cesspool permitted if public sewer is available-within-200-feet.) � Septic ank: Distance from nearest well___'.�..0___ -_Distance from foundation--_-.-�d_� �Material____/. ------------------_--._.---_ ---,--_-_.-..____-__. , No. of compartments-..___y._____...--Size_3'-X---g_�ii __S�Liquid depth____._._�--------------Capacity._d--r-!?_0_ 4_- W Dispos field: Distance from nearest well_.,F __'___Distance from foundation----/.,*.._........Distance to nearest lot Number of lines-----------L--------------- -- Length of each line-------.fo_-----------.-.Width of trench----�_.--.--------------.----..-- Type of filter ------Depth of filter material-------/�__---______Total length------_1�-_4___------ ------------------- Distance to nearest well-----lviv-------Distance from foundation-----Aa----___-_.D•stance to nearest lot ------------ ;� 11Number of pits--------/----.------Lining material-------Sr2...........Size: D' ----Depth........?----------------------- ': a Cesspool: Distance from nearest wO-----------------Distance from foundation......... ------.. Lining- material _..____..___________--___--.------� ❑ -Size: Diameter-------- -----------------------------Depth----------------------------------------------------Liquid C'apacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------._____Distance from nearest building----------.--_----------------..__-..__._- ❑ Distance to nearest lot line---.__------------------------------------ I Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------- ---------- I �. _. ..---------------_. --------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------•---- ----------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local'Health District. ..(Signed)------------ --- -------------------- - ----- ------- - - ------------------------ ------------------------------------------------------ and/or Contractor)C - - BY:--------- -•-- • - ----- -'�------ - -=- ---------- ---- - - -- - ----------------------------------------{Title)---------y--------- ----�---- - (Plot plan, showing size of lot, location o system to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ - ------- - ----------------- ---------------------------------------- DATE--- -p--l.7. ` REVIEWEDBY-------------------------------------------------------------------- ------------- --------- --------------------------- DATE--------------------------- BUILDINGPERMIT ISSUED------------------------------------------------ --------------------------------------------------- DATE------------------------------- ----- Alterations and/or recommendations----------- ----------------------------_---------------------------------------------------------------- ----------------------------------------------------- ----------------------------------------- 14-01 l FINAL INSPECTION BY: . - - te '-----------._____.__ Date---- �re,----'�-1�7 -------- --- - - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC3.