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FOR OFFICE USE: zX;iv _----- _ _----9. � - 4. 'APPLICATION FOR =, SANITATION PERMIT Permit No. l `7" _ --•-- ------- --------------------------------------.: (Complete in Duplicate) ---_.-_ This Permit Expires 1 Year From Date Issued bate 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. - JOB ADDRESS AND LOCATION___--_-- - ---, -. Owner's Name----------------------/C. i.---lam-�0--,6_r,-X--•------------------- --------------- - ---- ------------------------------ Phone----- Address_-----------------• -• Contractor's Name- �� 1- r ` -------------------- Phone-_'A .�. 10� i Installation will serve: Residence ❑; Apartment House ❑ Commercial ❑ Trailer Court 0/(vlotel ❑ Other ❑ Number of living units: 4-- Number of bedrooms _-�_- Number of baths --f---- Lot size -------------V 612 ,-_-------------- Water Supply: Public system ❑--` ommunity system ❑ Private ❑ Depth to Water Table -------- ft. 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 [E— New Construction: Yes ❑ No [ 'FHA/VA: Yes ❑ No 2-` �. TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] I Septic Tank: Distance from nearest well--------------_-Distance from foundation------------------- Material-------------___-----.-------------------------- �. p k Liquid depth--- - --------Capacity------------------- ❑ No. of com artments__________________________5ize----__-------_--------_-- - _ - D:sposa3 Field: Distance from nearest well__-- .--.--Distance from foundation---/0-----._-_.Distance to nearest lot line-_ 2 Length of h l ---------------Width of trench � -_----- 4-'f---_--------- Number of lines_f-.-�------1--_-_/ ---------- engteacine__--, P--� Type of filter material----*�1��f --Depth of filter material---/If"--.---_-.Total length------- a-- _-------- Seepage Pit: Distance to nearest well---.----- - ---Distance frofoundation---*---_-.Distance to nearest lot line / 6 ©l Number of pits---I-----2----------Lining material---S Q .Size: Diameter_-' _`--------Depth-- -------------------. Cesspool- Distance from nearest well------------------Distance from foundation------------------- material--------.__-------------------------- ❑ Size: Diameter------------------------- Depth ----.-------------------------Liquid Capacity------- --------------------gals. Privy. Distance from nearest well----- --_--__--------------_----.----Distance from nearest building------_---------------_-_-_-_----------. f ❑ . Distance to•nearest lot line------- ------------------- ---------------- ------------------ --------------------------------------------------- ---------------------- 12emodeling and/or repairing (describe):.......141"K, descr e):_.-.- !/--. ----i_ ---------- . /-------------------------- LLLh -----------_----------------------------------------------I------------------------------------------------------------------------------------ ------------------------------------------------------------------------- ,1 --------------------------------------------------------------11------------------------------------------------------•-----•--------------•------------------------------------ ---------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- --------------------- 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 laws, and rules and regulations of the San Joaquin Local Health District. l I--- I. (Signed) ' � w By:---------------- ---- --:----- --------------------------------------(Title)----------- ----- -------- {Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side]. ; . } FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY---- - DATE REVIEWED BY--------------------------------------------- - -- -- -------------- ----- -- ---------------------------------------- ------------------ DATE--------------------------------- ------------------------- BUILDING PERMIT ISSUED -4 <= Alteratia and/or recommfnd +ions:---- �,, -- -- �c.P---- �,,,_--CEJ-- ---------- ------ ----------------- - -------------------- ------ .................... FINAL INSPECTION BY:----- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Y Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.