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1—UR OFFICE USE: 11� ._ -------- ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. "` (Complete in Duplicate) ................ This Permit Expires 1 Year From Date Issued 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------ 4 4 S' E. `3 � .37-, S-7-K/V- _ -- -- - ------------ ---------------------------------- Owner's Name------Mx_t------- -+---------- r -----"----------------------- ------ Phone._`__16 O. Address--------......----------------C'S-p-m--6------- - - Contractor'sS wL_+r- e— Phone-` 31 �Z ------ Installation will serve: Residence Apartment House ❑, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: __I-.-.- Number of bedrooms ,3_z Number of baths ---[.._ Lot size --.---- S_�_ � �F -- X-----1--tea `- ---------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --6q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay t] AdobeX Hardpan ❑ Previous Application Made: (If yes,date------.-- ____--) No New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No)y 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----A - .......Material ----------- -- . No. of compartments dept ._y._S+.-..-.___ Capacity-- ------ --_-.-- _- uid h-_ Disposal Field: j ' Disfance fr m nearest well_""".._�"`��Distance from'foundation'��-_-i`-"Distance to nearest lot l'i'ne---s�_�_ ❑ e � Number of lines-------------- J---,_--------Length of each line--- -SZ?--.{Width of trench------_.01 -- _X7 ------- r Type of filter material-- . _�;�_____Depth of filter material-------_� -1 ---_Total length_------_ S ----------------------- t S-( Seepage Pit: Distance to nearest wefl_-I._Q_4.e_--„,.Distance from foundation-_-__-q_�__.--_:Distance to nearest lot fine__-s-----_- Number of pits-f_--- --~. 'Lin.ing'ma+erial s .-,-.Pp�ZSize: Diameter----�__� . .....Depth------__Z .- Cesspoo : Distance from nearest wOff �--------------Distance f ororrh foundation-+ -------------Lining material--.-__-...----_----.__._--------.-_ (n ❑ Size: Diameter -------------- ------------, Depth --- I\N-------------- ', Liquid Capacity gals. r P'r•ivy: Distance from nearest,wei!--------------- ----=------- ---=�_- - ,Distance from nearest building w Y t� ❑ Msiance to nearest R . lot--l-ine--------------------------------- Rem ------ ----- Remeling and/or repairing (describe) i ------4o / - 1s --- i r t' s i - i --' ------------_.---..----� �--------------------------- -- -- ' ---------------------------------------- --------------------------------------------------------- - -- hereby bYcerY thIhaveprepared thippli d 6f he work will be done in accordance with San Joaquin County ordinances, Statelawand and regulations the San h � Local Health District. c4i_ (Signed) +- - ---------------------------------------------- ---- {Owner and/or Contractor) - --- ------------- BY - - ---- - -- ----------------------------------------------�'ATitle) (Plat plan, showing size of Eat, location of system in relation to wells, buildings, etc.; can be placed on reverse side). F It FOR DEPARTMENT USE O LY #' APPLICATION ACCEPTED BY---------'- ---------------- - ------------------------------------------------------ DATE.--- ----------------.G” • REVIEWEDBY- 1---------------------- ---------------------------------------------------- DATE---------------- BUILDING PERMIT ISSUED--------------- ---------------------------------------------------------------------- -------- DATE------------------------------ Alterations and/or recommendationsc-.__'- "" --� ----- -- ` ,� -------5------------ ----------------------------------------•---•-----• ------------------ 1 ¢ } ---------- -------------------- -------- - i ? --- ---------------- r -------------------------------! ------------ -- ---------------------- --i V t FINAL INSPI=CTION�BY�"` l. ,1 / Date. S-- -------------------- , _l' �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaxelton Ave. 300 West.Ook Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.