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F /mss-=- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ....... _•L�Q ! --------- ---------4--------- '------------------------ (Complete in Duplicate) ---------s- ------------ Date Issued 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 with County Ordinance No: 549: - �� h JOB ADDRESS AND OCATION_! ./ CL -_W4,se Z. - �/�. �. Owner's Name---- - --P;;?j,% ©6I—e f.S1' ++ ll ------ a.J/ / ' !/ Phone------•- ----------- Address-------- � ------------------------------- •---- -- ------------ ontractor's Name-____. IQ��J,S' �¢/ _ '��' Installation will serve: Residence [3- ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: _L.___ Number of bedrooms _• __ Number of baths ---%3- Lot size _� f s" ---�49zP_.-- ------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table'$ ft.04, s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ['Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: (If yes,date... ----------- - No [� New Construction: Yes [�' No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sbptic.tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest W-611-5p------ from foundation_,�� J " Q/ t - ----- --:-.Material---- No. of compartments-------�:-----------Size__4_ _TJ _/�-.-Liquid depthi,f �- --- --- - - ---------Capacity/ � d Disposal ield: Distance from nearest weft...,t� ---r '-` ' f2 -laistance from foundation----!;`1-__...._.Di tante to nearest lot line__/__`. Number of lines.--#___- _. Length of each fine d GO' ^1 a g "Y -- of trench---, --------------- ?Type _ of filter materia._ _-Depth f f �'.�,��h'._De th of filter material length____"` __ ____ Seep Pit: Distance to nearest well-la&---_-------Distance frofoundation--- I _ ' Distance to nearest lot fine _,�'`-�---_ Q' ..=-------- Nsimber of pits----- -3-----------Linin material-_ _ . t 9 ®L` -Size: Diameter._ ------------Depth---.a �"----------------- Cesspool: Distance from nearest well-----------------Distance from foundation ------------------ Lining material---------------.-- ❑ Size: Diameter---------------------------------- --Depth------------------------- -------Liquid Capacity- ---------- gals. Privy: Distance from nearest well ------------------_-_--------- -- Distance from nearest buildin ❑ Distance to nearest lot line---- g------- -------------------------. --------------------------------------------------------------------------------------- - - -------------- Remodeling and/or T�repairing (descriR:__ __.----_ ��_------ -__ t.t f 1 --------------- --------------------------------- ---------------------- -- ----- - -------------------------------------- --------------------- ------------------•----- -------------------------•----------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la rules andlregulations of the San Joaquin Local Health District. (Signed) --------_-- w and/or Contractor) - --------------------------------------- By:-------------------- ..u� Title ---- ----- ----------- g P (Plot plan, showing size of lot, location system in relation to wells buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----__ REVIEWED BY ---- ------ •------------------------- -- DATE- -------------------------- -- --- ---------- � ~ � ---- --- ------- BUILDING PERMIT ISSUED ------------------------------------------------------------ -------- DATE----- -- �{ ---------------------------------------- DATE----- -------------------- _ -------- ----- QAlterations and/or recommendations:_- . 5 11 -- ----- -------•-----•----•------------- -------•------------------------------------------------- - ---------------------------- -- -- --- ----- --------------------------------------- - - -- --------------------- FINAL INSPECTION BY:. :---- ----- -------- - 2 Cr Cpl` Date__.. . _ f_ -k ------------------ - -------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes+9th Street Stockton,California Lodi, Lolifornia Manteca,California Tracy,California F.P.CO.