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-.r r FOR OFFICE USE; /Z--0I---------------- Permit No. .�� /- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------------- Lam_f----- Owner's Name---------- - �� ---- �--�d - -------------------------- ------ Phone-------------------•--------------- Address----------- -•-•---- ----- ...........!/ -�Y ©/V---------------------------- ----• -------- Contractor's Name---------•------ -- --- / -1 ------ - '�------------------------------------------ �- Installation will serve: Residence OK'Apartment House ❑ Commercial E] Trailer Court ❑ Motel ED Other El s Number of living units: -_-E*--- Number of bedrooms -------- Number of baths -,Z--- Lot size ------fl9-G7_1U....A42----------------- Water Supply: Public system M, Community system ❑ Private ❑ Depth to Water Table -------- ft. i Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ F Previous Application Made: (If yes,date.-----------...------) No ET"" New Construction: Yes ❑ No W FHA/VA; Yes ❑ No C3--' 1 TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ateria .--__._-Distance from foundation-��..........Ml__ --/ _e�ll4t ------------------ I Septic Tank: Distance from nearest well--. L' No. of compartments....... --------.--Size- - _ -.K-- Liquid depth--- --'�------------Capacity- --- Disposal Field: Distance from nearest well------- ---------Distance from foundation--------------------Distance to nearest lot line-----_.--------. Number of lines--------------------=---------- ---Length of each line---------- -----------------Width of trench.----------------- ---------------- 4 Type of filter material--_--__-----_-I--------Depth of filter material-----------------------Total length------------------------------------------ Seepage Distance to nearest well----------------------Distance frorn,4oundation----_ .__.Distan`6to nearest lot line----3 __.- go Number of pits---------/---------Lining material----- Dia 00------Depth------� -------- - -- Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material---.----..._-------_-------_--_---- Size: Diameter------------------------------- ------Depth- --------------------------------------------------Liquid Capacity_.----------------- gals. Privy: Distance Distance from nearest well--------------------------------_----------------Distance -from nearest building------------.___---.-----------.___.---. ❑ Distance to nearest lot lire- - ----------------- — ---------- Remodeling and or re icing descrl e} _-._ , �j �' - ---- ------------------------- ! hereby certify that I have---r----aced this '-------------------------------------------------------------------------------------------------------------------------- ------------- -------------------------- -------- ---- Y y P application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rule a regulations of the San Joaquin Local Health District. ----------- - ---------------- --71w- r and/or Contractorl ---------- (Signed) ------------------------------------(------13 (Plot plan, showing size lot, location of s s+ in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.�--=1/-- -- - --- DATE-- = ~ ---` ------------------------------- REVIEWEDBY- ---------------------------------- ------------_-----------=--------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------- - --------------- - ------------------------------------------------ ---------------- D�E-- ----------------------- - -------------------------------- 7 Alterations and/or recommenda+ions:4 - ---1-Y-_ta�`---: �,e�'��- sa �= ` ------------------------------- ---•------ -1---------------------- --------------------------- FINAL INSPECTION BY:.. .L Date------- --'�.. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 o.