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_______________________________________________ .Fj/jam �y ---- - ------------ ----------------- APPLICATION FOR SANITATION PERMITPermit No. j -------.."---------- -------- ------------------------- (Complete in Duplicate) V/ 1J. ----- ----- -- -- - - 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 con tr tt and install the work herein described, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION}_1- -- _-" oz_r -- Owner's Name------ /T" - - -- - a /� i ' AV --------•- ----------- /F Address-_ Phone *� -- ------------------ on ractor's Name_ f - - -- - ------ ---- ----- --- -------- Phone ___ Installation will serve: Residence [ Apartment House ❑ Commercial [] Number of living units: " Trailer Court ❑ Motel ❑ Other ❑ s g ,�_._ Number of bedrooms ._�-__ Number of baths _l Water Supply: Publics stem -- Lot size -----, '. `O,9~" '1' O PP y' Y ❑ 'Communit system `-"'--�' ----------- Y Y ❑ Private Depth to Water Table s?p- f}• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Previous Application Made: (If yes,1date.____-..__._ -- ❑ Clay Loam ❑ Clay [3 Adobe Hardpan E] ECIFICATIONS: ) No New Construction: Yes No (�' FHA/VA: Yes El TYPE OF INSTALLATION AND SPJ (No septic tank.or cesspool permitted if public sewer is available within 240 • I feet.)Se tic Tan • Distance from J� nearest well-----------------Distance from foundation No. of compartments-------- Size ------------ ----------Liquid depth--"------- ---------------Capacity--------- ------- Disposal Field: Distance from nearest ------------ Size Distance from foundation__-�Q.-___- .Distance to nearest lot line___ Number of lines._I____,,7-- ---- ------ ---Length of each line �I4a-�aQ s�•'--•- Type of filter material--- pC -" pepfih of filter material___ Width of trench.----p2 `- f �r Seepage Pit: ------ --------Total length---.,/nZ_cs---- Distance to nearest well__________________ Distance from foundation--------_---______.Distance to nearest lot line Number of Pits___#..-_--"__.-____L•rning material-__ I --------------Size: Diameter--.---'-- -------Depth--------------------- - Cesspool: Distance fromnearest well-----------------Distance from foundation______- ❑ --."_-_-_-_-_--_ Privy: l Size: Diameter-------- ----- Depth--------------------- Lining material__------Liquid Capacity- als. Distance from nearest well------ --"�--""" ---- -'---g ---------------------- __.___-Distance from nearest building F1 Distance to nearest lot line. g ; - Remodeling and/or repairing (describe):-----_----�('�,� I ✓ - -----------•-----•------•------------•--•---------------------------•-------------------------------------------------- --------------- i ------------------••-------•--------------------------------i------------------------ -----------------------------------I-------------- ----------------------- - ---------- --------------- ---------------- = t ; --------------------------------------------•------------------------------------------- -- 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)------ r BY: -----"(Owner and/or Contractor) g! ----- Tale. (Plot plan, showing of lot, loc ion ;of s s ( } ��r� '� - I y em in r anon to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ----- _ REVIEWED BY-- - -- ------------------------------------------------ - DATE__. _ _^_ ------ --•--- DATE------------ ------- ILDING PERMIT ISSUED-----•-----------•--------------------------------------------- ---- ------�-- ----- -�--- ------------ - ------ DA•TE--------------------- A aerations and/or recommendations =' ----------- ----- -. FINAL INSPECTION BY:. )—ti -- -------- --- ------.-. Dater ------ -------- � b SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street ]24 Sycamore Sheet Stockton,California I Lodi,California 205 West 4th Street : Manteca,California Tracy,California