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APPLICATION FOR SANITATION PERMIT Permit No. L1F �iZ.:6. ................ - ......I.......... - (Complete in Duplicate) Date Issued _✓1:. .a:.ts� ---___------- --- This Permit Expires 1 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-----'i-L/ .l. ---------/`'- f--- - - Owner's Name .. <-----------f _------ --- Phone Address i G !_l h :. �/ . ------------------------------------------ --- Contractor's Name... ... . .,............;.. it !� - --_!. •... .. Phone. /i:%_fir..: .... Installation will serve: Residence 0 -Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._ Number of bedrooms . s_,.. Number of baths _-1.._ Lot size __.. - 1__._.-..__.-.-------. Wafer Supply: Public system ❑ Community system ❑ Private JE Depth to Water Table .'-_eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam m Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date ....._....... _.-) No ❑ 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 foundation----------------_-Material---- ----_.......................-.__._.. ❑ No. of compartments------------ -----------Size------------------_..........Liquid depth--------------------------Capacity----------------_- Disposal Field: Distancefromnearest well..__:'Z `...Distance from foundation._„!{_:c.._...._.Distance to nearest lot line__ <_'_.--. Number of ,lines-----..L__....... .- ._. Length of each line---Z2G11Z_f__t-_----..Width of trench.._--S�L..r-------._------ - Type of filter material_f1- %Zf_'Depth of filter matel-W.. ::-F."___._.Total length-------Ze'......-------- __------ Seepage Pit: Distanoqto nearest Distance frgrn foundation l c__-_ Distance to nearest lot line ..... Number a its.. /_...._. Lining material y//i!1^ a;i�__Siza Diameter < a ' `--- -Depth.._ ! ----------------- Cesspool: Distance from nearest well----------- from foundation------ ------------Lining material--------- --- ---______..___--- ❑ Size: Diameter- ...:-------------- ----------------Depth.------------ - ----- ----------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well,-----_-------------------------------_. ------Distance from nearest building----- -----------._..............._.._. ❑ Distance to nearest lot line-------/----------------------- --- ------------- - - -- --- -- -- ------- Remodeling and/or repairing (describe):-------.��:(.-l _---`--------- .` 1-!='% -c-`------- ---..`- a/ :erE;---..-....`.. ------------------------------ ...........----------------------:-- ------------ ------------------------------------------------------------------------------....-- -:------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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) . - Owneyand/or Contractor) (Plot plan, showing size of lot, location of y tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' -L - - DATE_._..--- S C =------ APPLICATION ACCEPTED BY...._ ....__..._ _r------ //2-_ REVIEWEDBY............... ------------- - ... - - ------ - - - ---..._......-----. DATE----------------------------------------------------- BUILDING PERMIT ISSUED_._-__-- DATE:.._...____.__-.____.-___..._.-.._.. n � �� i * Alterations and/or recokrlmendations:..._..._J_�.. _9— ..�_..6.1 !^c�c r'""-c_"�_`_..'__ .�_ti.._...)--------------------- ------------ - _... -- --------- - --------------' --T-,-----' `-'_`= -----`-' -..------=- ---r----l.:.'.-.-�. --------------------------- ------------------------------------------------------------------------ _.......... --------- ------------------- - - ---------- --------------------------------------------------_.._...------..------------------------------------------------- ....... --------- ......._... - ----- - ---------------------- -------- ---------------------------------------------------- ---------------------------------------------------------------- ------------ -. - .... . - - - ------ --------.- -._.. --------------------- - - - - — - - ----------------------- ------------------ ----------------...------ ---- --- --------------- ----------- -------- - ---- FINAL INSPECTION BY:._--ArJO .2a Date- ---� fj - - - - - / - -SN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 11110 Stockton, California Lodi,California Manteca,California Tracy,California r P.co.