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FOR OFFICE USE: / No Permit . .. APPLICATION FOR SANITATION PERMIT -!- ..: l (Complete in Duplicate) - -- �s '/•—_-ref Date Issued ...----...,1..---�� F 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 withCountyOrdinance No. 549. JOB ADDRESS AND OCATION__ � d4_ ,-•----------------------- ------•-- ------------------------------------------....----------------- Name_ =i z`-- .--- - ----------------------- -----•----------------------- Owner'sPhone - -- -_-.•. - - S - - f ........... Address-----.-----: IL; -----• Phone--•---------------•--------- Contractor's Name------ �-- �.. ----------•------••------•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [-I Number of living ,units: ___ "" Number of bedrooms _,:-7 Number of baths -_ Lot size .. cS'X_/." --------------- ----------------- Water Supply: Public system [�LOmmtunity system0.,P_riv�a"te`❑ Depth to Water Table �6 ft. Character of soil to a depth of 3 feet: Sand.I] Gravel El Sandy Loam ElClay Loam E] Clay E] Adobe Ej—t lardpan E] Previous Application Made: (if yes date__{------------------).;fNo.22/New Construction::Yes o ❑ FHA/VA: Yes ❑ Na �---- fi TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank.or cesspool permitted if public sewer is available within 200 feet.)_ SeptTank: Distance Distance from nearest well-----------------_Distance--from'foundati'ons---{_...-___.__..__-Material------------------------------------------------- No.'of compartments_------_------- -------Size-------------•- •--------Liquid depth--------------------------Capacity.---•---------- f-•-- Disposal Field: Distance from nearest wellnJ��_.±.Distance from foundation._/.G-�-----------Distance to nearest lot 1ine...`S- Number of lines:_ "_______ ________________Length of each line______" _ el --------.Width of trench----- Y ---------------- s •• v of filter materia_�=.. "�'_ ------ of filter matenal:__��_____________Total length...... ___ See a e Pit: Dit f f �f Type P g ante to nearest well___!1s4__--_±._Distance' m foundation___,1.____....___.Distance to nearest lot Iine___ �_____.__ Number of pits.- J___ •----------Linin material___-- " :----- g i Size::Diameter-----�X--c-------Depth----- LAY _ ) \j' Cesspool: Distance from nearest well______________4_-Distancerfrom*foundation...-----------------Lining material__._____.._.--_______________-_-_____. V 1 I Liquid Capacity Is. ❑ Size: Diameter--'-----:---------------•----------.-.Depth----•�----------:- -- -----�--- ---- :-------•- q P Y-------•-•-----•------------9 - a 3 Privy: Distance from nearest well--------------- ----------------------------__.-Distance'from nearest building-_---_------.-------•---"----------------- ❑ --------------------------- Distnce to nearest to"t-.line------------------------------ r Remodeling.and/or repairing fdescribe: __._._ •------ - ••---------------------------------------•----- -.-. ------------------------------ --------------"-•---•-•--------•-------------------- --------- - ----------•------ ------------------------------- -------------------------- --- --------•-------•------------=-=---------=-- 1 I hereby certify that I have prepared this applicati_ _on and-that the work will beidone in accordance with San Joaquin County ordinances, State laws, ;and rules and"regulation of the San Joaquin Lcal Health District. (Signed) I -- -- ------- - --------------------------------- (Owner an------------�------------------• -----------{Ow r Contractor) or > )BY= := = ----=----------- --------------------- (Title) (Plot plan.,showing size �f lot, I of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEED BY--- O- � sl�N`'`cc PT ------- -------- DATE . REVIEWEDBY-------------------------------------- : - ----------- -------- ------ ------------)--- __ DATE BUILDINGPERMIT ISSUED----------------- -------------------------------------–--------i-----------_-----j------• DATE------------------------------------------------------------- ____________f..................Alterations _____.......-.. Alterations and/or recommendations:._ ---------------------------- -------------�-°-----"•--- -• -- ..............-------•-•------------...-•;-------------------- ---------- I- ) - ------- --- ••---------------- . -----------------------_-------------- r� _-_--.__ _ -i • ------- ---------"----------------------------- ---------------- -----------•----------------------- --------------- ------------------------------------------ �" Date"-�-_-- ---------------------------------------- FINAL INSPECTION SY:.... SAN JOAQUIN LOCAL HEALTH DlblKK,T 130 South American Street ?�I 300 West Oak Street 124 Sycamore Street - 4 ''205 West 91h Street Stockton,California , Idd i,California Manteca,California Tracy,California E9.4 FEVI6 EC 9-94 V.P.0 D.7M 6.66