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---------------FOR OFFICE USE:a ��- �, 3` 3a APPLICATION FOR SANITATION PERMIT Permit No. . _7 (Complete in Duplicate) -1 / -------------- - ------ This Permit Expires 1 Year From Date Issued T' " 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 inicompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____________ Owner's Name ' e1Lf6? --I---------- Phone------------------------------------ Address----------- ------------------ -/-W. Contractor's Name-------------- ...... ------------------------------- ----------------------------------------------------- Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L] Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a deptk.h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION SAND 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______-__._.__--__--.-______--______-_-_______. M IJ�7� No. of compartments Size Liquid depth Capacity t Disposal Field: �istance from nearest well_,________________Distance from foundation--------------------Distance to nearest lot line_-____________-. 25Y Number of lines-----------------------------------Length of each line-----------------------------.Width of trench.---------------------------------- Type of filter material-------------------------Depth of filter material-------------_,_------Total length____.-.__________ _.--________________-._ 04 S page Pit: Distance to nearest well...... ---------Distance f m foundation....k..........Distance to nearest lot �ne__--------____.__ r Number of pits-----------I----------Lining material____ . _Size: Diameter__—Y.. ___. Depth 2!?.47___,J. - -_____-___._ Cesspool- Distance from nearest well-________________Distance from foundation--------------------Lining material------------------ ___.________-_-_.. ❑ Size: Diameter------------------------------------- Depth----------------------------------- ---------------Liquid Capacity---------------------------gals. r Privy: Distance from nearest well _______________-----______----------------------Distance from nearest building--------------------------------____-._.-. ❑ Distance to nearest loft line_:______.-_ -- --- -------------- e r:. Remodeling and/or repairing (describe): .arCa-t , 7 � t ----------------------------------------- -------------- _ J`_-- h ------------------------ ----------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that 1'.have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State land les and regulations of the San Joaquin Local Health District. ruT k (Signed) E1 - ------------- --------------------------- ------------------------ -------.(Owner and/or Contractor Plot Ian,--showin -size of lot, caAnoftemin Title____ C. - _( p g relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; BY----- _._. __-__C ------------------------------------------------ DATE-------- REVIEWED BY------------------- 1-------------------- -------- -- - - DATE --------•-------------------- BUILDINGPERMIT ISSUEDI----- --------------------------------------------------------------------------------------------._. DATE.-------------------------d Alterations and/or recommendations-------- --------------- ---------------- ---- ---------------------•---------------------------------- -------------------------- ---------- ------------------------ - - ------------------------------------------------------------------------------------------------------------------------------------------------ --------- -----------------------•----;------------------------------------------- -- ---------------------------------------------------- • M FINAL INSPECTION BY::----- ----------------------------------------- -- Date-------U'---------- - -- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. , 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-CO. i :�