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eU�UH-]Ltust: _71/a-/I-Z-_______________ _____ _ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- ------------ (Complete in Duplicate} 7 Date Issued ___ ---------------------------------------.................. 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--------1-64_1�'— .rJ, T ------------------------ Owner's Name---- -------------- -40_�1---------------------------- - ----------------------------------------- Phone..-------------------------- ---•--- Address------------------15051_m-�F--------- Contractor's Name----- -------- t//GC"-------------------------•----- Phone-4�f-+- -1/ �jf Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-- Number of bedrooms --c:R_ Number of baths ---/_ Lot size ___ �_X__I,S -----__----_--______-- Water Supply: Public system Oecommunify system ❑ Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan E❑ Previous Application Made: (If yes,dote_).'?S?-------) No ❑ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti aqk: Distance from nearest well-----------------Distance from foundation-------------------Material_...----..-.--------.._________-----_--____----.. No. of compartments-- ---- ---- ------------Size--------------------------------Liquid depth-------------------------Capacity.---------------------- - i o' Id: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of fines-----------------------------------Length of eachline----------------------------_.Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well-,N�d�C_____Distance from foundation--.02j-+---.Distanc� to nearest lot line.... Number of pits------ ........Lining material-;9_0 ! ,( __._.Size: Diameter---740-- ----- Depth_._....- _---____-..__.___ Cesspool: Distance from nearest well-----------------Distance flolm foundation.-------------------Lining material--------------_---------------------- Size: -- ----.--------.Size: Diameter- - -- - ------------ ----------------Depth----------------------------------------------------Liquid Capacity------------- --------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----------------------------------------- 0 ,. ❑ Distance to nearest lot line ---------------------------------- ----------------------------------------•---------------------------------------------------- CY Remodelingand/or repairing (describe}---------- ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------•-------------------------------------------•------------------------------------------------------------------------- ---------------------------------------------•--------------------------------- --------------------------------------------------------------------- --------- ------------------------- r ----- ---- ----------- ---------- - ------------------ -------- ---------•-------------------•-------------------------------------------------------------------------------------------------------------------- ------ 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)------ei�'ry ------- ...................... 1. 'r//G --- --- -------(Owner and/or Contractor) By:------------------------------ (Title) -_ - ----- ------- ------- - - ---- ------- (Plot plan, showing size of lot, location of system in re ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----- ----------------------- DATE------J ---- - - --------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------._ DATE----------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Al ton and/or r commendations:-...-------_._ � a 7 _ �1 ------------------- . ----------------------------- ----------------- -------------------- - ------------------------- ------------------- ------------ _________________--------- 7?. i�YJ9_.e�.. ..lR+�tiet'}_ --/��!� _ _`.__._____t/,_ __ ___ /. ^ '-.e' =[-.Q�' -=.��-t'-aveyee�Ti�'�.�.�^'� �• - --- --------------------------------------------------------------------------------------------------------------------------------- [�J FINAL INSPECTION BY:..........e_lp---------------- -------•--------------- Date------. ---- --- -- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R CC.