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FOR OFFICE USE: 1 ,- -� --��- -- ��____�-_____-.�'� APPLICATION FOR SANITATION PERMIT Permit No. __.. - � -- -- -------------- -- ------------------------------ (Complete in Duplicate) - -- -- ---------------- -All------- - -------------- This Permit Expires 1 Year From Date Issued Date Issued ___7i, ---- - ,/pS Application i lFhereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatign is made in compliance with County Ordinance No. 549. JOB ADDRESS AND l LOCATION.�_______ -_ ----- __ 0 Owner's NaA___ � � - A .!f �L7 - ----- Phone_f.. -` ---- - -1- Address ---'--=i� zl v �_`' _ [-� ��C� Contractor's Name-----.. --------•---------------------- Mh •------- = ------ Phone-- _- 7t� -- --- ---------------------- Installation will serve: Residence ©---Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ofher El Number of living units: __/___ Number of bedrooms _2—Number of baths _-___ Lot size ___--_&_V Water Supply:l, Public system E] Community system E] Private [�epth to Water Table 45,t_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe -ardpan E] t Previous Applination Made: {If yes,date--------------------1 No,❑'� New Construction: Yes E] No Kj�FHA/VA: Yes ❑ Nq� TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepific tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__-;7�� stanati�n__.I_�I I z�� Distance !LL/from fond --------Materria�-_/t - rT!J . ] No. of compartments---------- __Size----F =L-Liquid depth------ _ Capacity-r�' --,;2 ' Disposal Field: Distance from nearest well-------------__-_Distance from foundation--------------------Distance to nearest lot line__________---___ Number of lines------------------ ----------------Length of each line-----------------------------.Width of french Type of filter material--------------- ---------Depth of filter material-----------------------Total length_________________:____ -------- _____________ __ ----------- Seepage Pit: Distance to nearest well _________Distance from foundation_________________ Distance to nearest lot line-___-_____--_____- i I ❑ Number of pits---------------------Lining material---------------------Size: Diameter---------------- - ---Depth---- - ------------------ I Cesspool: I Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------___-_ ❑ i Size: Diameter------ ------------------- --------- ------- -------------------------------------------- Depth '-� Liquid Capacity-- -------- -------- --•--gals. � ) Privy: Distance from nearest well-.__________._________________----------------Distance from nearest building ❑ Distance to nearest lot line_______________________ _ Remodeling anal/or repairing (describe):--------- d -� -� �E•�� 1 - -------------------------------------------------•-------------------------------------------------------------- -------------------------•I---------- -------------------------------------- ; ----------------------------- --------- --------------- ------------------------------------------------------------------------------•-----------•---------------.---------------------•----------------------------------------- f I herebcertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Late laws, and rules Ind regulations of the San Joaquin Local Health District. (Signed] [E 7_7 \ (Own------ --------------------- er and/or Contractor) By---------��-------------------------------------- ------- Tale ; (Plot plan, shoJing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION�IACCEPTED BY------------- -�� DATE ----- - ------- ---- �� -_1,2 REVIEWED BY,,l ------------------- DATE------------------------- -------- BUILDING PERMIT ISSUED-------------- --------- ------ DATE_- -------------------------------------------------------. Alterations anOor recommendations:____ � _ 6r C.._--_-__--_---___��'�'�`��-cam � � �;�.t� -- ------- --mss .�� T _ _ c -- _ �. ________________'-_ _ _ 4 t �+ ----- may-- J P--- �C Gr 1�_Y� cy_� t�Lr a1c��..--C -._-_'______ 4_ --- ----- 1'---- ---.._- YYom- y�� z .JDate_- FINAL INSPECTION BY:------- -. - ----------- - ----------------------------------------------------- i i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' I i Stockton,California Lodi,California Manteca,California Tracy,California