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OFFICE USE: f - ------------------ ------- APPLICATION FOR SANITATION PERMIT Permit No. ..f. - _�.!_._ ---------------------- ------------------ -- _ - ----------------------------------------------------- -- (Complete in Duplicate) S S` Date Issue ----- ----- ---------- This Permit Expires 1 Year From Hate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta€I the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- jj d--------------------------• ---- --- / T ---------------------- -- ------ --- ¢p Phone__ J`X Owner's Name--------------------p- ------- U = _._:: Address-------------------------------Rg�..&--------S;V.,V�....+ ��- ----------------•-.......I------------------------------------------------------------ Contractor's Name---- l /Qlft� -��'11� •------------------------------------------------ Phone.._ 0�1?0 Of Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other ❑ Number of living units: __/-__ Number of bedrooms _3_ Number of baths __/___ Lot size ____.4-e.-- ------ ------ Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No ET" New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from founda+ion--------------------MateriaV-----------------------------------------._____- i ❑ No. of compartments--------------------------Size--------------------------------Liquid depth----------- ---- -------Capacity------------------- i Disposal Field: Distance from nearest well--------------Distance from foundatii�o,ff;�;___/D-_..______Distance to nearest lot line-----�_-_.._ ____.______Length of each line' 0_ +_._ .'¢(�.%� -Width of trench-._j ~------------------- [c�� Number of lines------�____-______._ g Type of filter material-_ +404&----Depth of filter material-_/ _�!--___-_-Total Seepage Pit: Distance to nearest wel -__ --._— ---_--Distance fro foundation_--/ f._.Distance to nearest lot line_-- p' /---- - -----Lining material---Size: Diameter----3-3 ----Depth- �� --- X Number of its_-__-.- _ --------- Cesspool: Distance from nearest well-----------------Distance from foundation-__-__--------------Lining material---------------------------- :--------- 6 ElSize: Diameter-----------------------------------Depth------------------------------------ --------------Liquid Capacity------------•- ------------gals. PrivDistance-from,nearest.-well_ p-� •-_:___. _ _:,! _=Dis#once;fro`m`nearest-building_: ___=:"'_•_7`--'__:_-_____--:_:_--- ❑ Distance to nearest lot line - ---- --------------------------------------=-- --•------------------------------------------------------------------- Remodeling and/or repairing (describe):-- --------C. 1_ f�/ _ _._ ilh-- ------------------- ---------- ------------------------- ------ ------ -- - -------- ----- ------- ------ 7i� �6------ -------------------- ------ -------------------------------------------`-- 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, es and regulations of the San Joaquin Local Health District. t- (Signed)---------------------- ,<`• f'�C ` .-----.—=-- ----------------- ---------------------------------- wn and/or Contractor) By:----------------- `.._ ----------------------- - ----(Title ---- --- - -- - ............. (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY.... ----------------------- DATE------- sG --S------------------ ----- REVIEWEDBY----------------------------------- ----- - -------------------------------- ----- -- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------ ----------- x--------- DATE------------------------------------------------------------ Alterations and/or recommend ations:---- 51r5c - ----- '---------------------- ------------------------ ------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------- - --------------------------------------------------- ------------------------------------------------- ---------------------------------------- ------------------------------------------------------------------ ------------------------- - --- -- - --------------------------------- --------- --------------------------------------------------------------------------------------------------------•---•----------- FINAL INSPECTION BY:-' - Date----- 5 --- ----- --- --- --------------------- ---------- k p SAN •JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. ,