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FOR OFFICE USE: _. = 5--------------- - --- -- --�j� - ------ ------------ 6-___._ APPLICATION FOR,SANITATION PERMIT Permit No. ./ �._ ..-J.... ---------- --------------------------OP- Date Issued ._ (Complete in Duplicate) _3) / ............... ---.------ This Permit Expires 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___.... :------�?r�-------- 1_,�',(�f�--------------- Owner's Name----------------- l:� - 1 t � Phone- x ---T Address------------------------------- — 1=-AF -------------------------------------------------------------- Contractor's Name-------------------- --4¢-'QrB / 1- ----r ''�-------------- ------------------------------------------- Phone.¢ �'---_-�� ._._ ._ .-- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El of living units: _.�_,__ Number of bedrooms _ Number of baths _--_1_ Lot size ------ ------------------- 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 0 Clay Loam [-Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date._ ) No Q"- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No 0— 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 foundation--------------------Material___--------------------------------------------- + ❑ No. of compartments--------------------------Size--------------------------------Liquid depth---------- -------------- Capacity----------------------- Disposa Fied Distance from nearest'wefi_ 1_---__Distance from foundation.._•.0._ .....Distance to nearest lot line_-50....€. Number of lines_. ._ __. _ �. -Len th of each line..._ ❑" - - - ------- 9 .:;;2r,�---- ---- ---Width of trench---'-'?�--ry----------------- Type -of filter material--- .___Depth of filter material---1,_`�---.--.-Total length----0457-11----------------------- Pit Pit: Distance to nearest well_./QE5__-.____Distance from foundation-___ __ f p g _Distance #o nearest lot line_1d______._ Number of pits-----------I---------Lining material__je<Ae __.__.Size: Diameter._. Depth_._.- .5___'__--____----- 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------------------------------ Distance to nearest lot line------------------------- ---------------------------------------------------------------------------------- ---- ---------------------- u1 ,/f 6 Remodeling and/or repairing {describe}:_ 1' _--_724___- I-ST/ l ______ 11 _, . --------------- --------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------- 1� 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 r and regulations of the San Joaquin Local Health District. (Signed) -(Ow and/or Contractor] By:--------------------- - •-�ion �--------------------------------------------------------{Title)---- '-- -' ----- (Plot plan, showing size o tem in relation +o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------F=Z�------------------------------------------------------------------------ DATE------ '.a fes` ------------------------------ REVIEREVIEWED WED BY------------------ ------------ --- -------------------------------------------- DATE------------------------ --------••----------------------- BUILDINGPERMIT ISSUED----------------- -------------------------------------------•-------------------- ---------------- - DATE--------- - ------------------------------------------------- Alterations and/or recommendations:_-___ -.-. ..................... . . } _ ------------ v------------------- �C ------------------------------------------------------------------ --------------------------------- �� - _-__-.___.-_•----------------------------------------------•--------------- _ _ -' .........----.----------------------.-----------------------------------.-..((.////-JJ.----.-. -- _-..--...._-_----.-...--__--._.--__..----_..._.---------.....--------_...-__----.._.___-__._________-_.____._._.____--._--_-._----.--_.._-_-. FINAL INSPECTION BY:...... ___-•- _ _-- Date---_�--7-6u-- - --------- - ----•- - - -- ------------ ---------------------------------------------- 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 r.P.co.