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FOR OFFICE USE: °rc'4V ------ ----------------------------- ------------------ ---------------------------------------__ ------------- APPLICATION FOR SANITATION PERMIT Permit No. c� _� ------------------ ---------------------------- -------- (Complete in Duplicate) _------------- This Permit Ex ires.l'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. X2'7 (� b `� .. JOB ADDRESS AND LOCATION_ �E2- --- -7?--------- --- ---------cf---- -/ ----- --------------------- Owner's Name_ /!✓ -( -------- _ { Phone -- ----------------------------------------------r-- Address------�-�-'---- '�-------�=-��---��------------ -- - -----------------------•--------•------------------------ 1 Contractor's Name----------'---------10 ;K -� Phone----••----------------------------- C - Installation will serve: Residence ®I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '_1----- Number of bedrooms",3_ - Number of baths _ -___ Lot size __ ----------•__--•_-----.--_--_-----_-__ Water Supply: Public system ❑ Community system ❑ Private ] .Depth to Water Table/4____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam] Clay E] Adobe C] Hardpan E❑ Previous Application Made: (if yes,date..__..-_..,--_.__.,�' No ❑ New Construction: Yes ❑ No.❑ FHA/VA: Yes ❑ No ❑ TYPE OF-INSTALLATION-ANDTSP-ECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v. 1 Septic Tank: Distance from nearest well_-$`--------Distance from foundation__.�_&I _____.._Material._.. 18� [ ] No. of compartmems__- s__.__------------Size__ _� _.:__Liquid depth_-___ _________________Capacity.! - --'�"_-- Disposal Field: Distance from nearest well_rb_____--_Distance from:foundat'on,_Z------------Distance to nearest lot line--j- -- ine__S3I of lines_ 3---•--t = ----------- -Length of each line - a--------------------Width of french_1--`I-- ------------- Number !J` Type of filter mate'rial �_ +1dYp Depth of filter material__-/,O# -----_-Total lengfh__12..�0- ---------------------------Seepage Pit; Distance to nearest wel . _____________Distance from foundation---------------------Distance to nearest lot line-___---_.___-.- k ❑ Number of pits----------------------Lining material------ ---.---------,-.Size: Diameter----------------------Depth-------------------------------- ++141. + Cesspool: Distance from nearest well-----------------Distance from foundation._.._._._______-_...Lining material--------__-_-.--__..___--___._____._ ❑ Size: Diameter.-------------- ---------Depth----- --- ------ -----Liquid Capacity gals. 71 p Privy:. Distance from nearest well------------------------------------------------Distance from nearest building----_------------------------ _.___.._.._. I ❑ Distance to nearest lot line �a Remodeling and/or repairing (descri(�e):------------------------------------------------------- -------------------------------------------------------------- -----------------------------------------=------------------------------------- --------------------------- ----------- ------------------------------------ ---------------------------------------------------- - ---•--------------------------------------------------------------------------------------- ---- ------------------- I hereby certify that I have prepared this application and that +he 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)*----- --------- - -------------- �_ ._ .t _--- ------• Owner_and/or Contractor]-.-[A By=------Xing �(.-------------------------------------------------------------(Title)------------------- -------------------- - - - - ------------ (Plot plan, sheze of lot, location' of system in reletion to wells, buildings,.etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY m, APPLICATION ACCEPTED BY----= DATE_ _'"�'` ----------------------------- REVIEWED BY ------------------ - ---------- ------------------ -- --------------------------------------------==-------- ---- DATE BUILDING PERMIT ISSUED = - -------------------------------. DATE---------- Alterations and/or recommendations:---- ------------------------------------------------------------------ -\ -- ----------------------- I____ -------- ------------------------ - -__ _ J tom" --------- 6� FINAL INSPECTION BY---------------------------- --------- Date.4--`_ r7__0'1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak street — 124 Sycamore Street 205 West 9th Street Stockton,California L*cli,California Manteca,California Tracy,California r.P.o o. r