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FOR OFFICE USE: t........................................................ ....................................................... t APPLICATION FOR SANITATION PERMIT Permit No..,1 ......................................................... (Complete in Duplicate) / ------------------ This Permit Expires 1 Year From Date Issued Date issued .--:5 _br --------------------------- _ 2.2� � 250,-31 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application ismad in co liance with County Ordinance. No. 549.�� JOB ADDRESS AND LOCATION_ .. W ��f - ---=- ------ Owner's Name ........ ctQ�,�............................ Address._.. .. IIr% c%19C�I�'►�r'Q/�,1.................. 19 ............................. ............................•-----••........... ...I ............. Phone ......................... Contractor's Name..lr%!!il.._..__......_................... = s... Installation will serve: Residence tr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living un . its. -_...... Number of bedrooms .: Number of baths@�..._,Lot;size. _y .............. Water Supply: Public system ❑ Community system ❑ PriJa+e eDepth to Water Tablego-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam ❑ Clay Loam;lay ❑ Adobe ❑ Hardpan 105 - Previous Application Made: (If yes, date ....................) No�ew Construction: YesI&INo ❑ FHA/VA: Yes E3 No [—^— TYPE OF INSTALLATION.AND SPECIFICATIONS: (o septic tank or cesspool permited�ipublic sewer is evadable wi+iin 200 feet.. N Septic ank: Distance from nearest vie'll...; ___. Distant from foundation ---- /D_------.Matplial�'Q L'_ _ _ F,...---.. W ,. No. of compartments...t:. ........... Liquiddepth._....-----____Capacity---- __,..�_. i �. Disposal Field: Distance from nearest well_Q..... Distance _from .foun-ddtion.__1.........Distance to nearest lot line ... Number of lines ....... ............ Length oT�each•';line_:.:.Q „_i�'-,..-Width of tren ch........r29f- ..... ............. r1r1 Type of filter material../OK.-`Depth oflfilter material--.__1.7-_______-__Total length- .!.?_.....--r--_--%. Seepage Pit: Distance to nearest well. -M-0 ....... Distance from foundation....) ....... Distance to nearest to line..... --...'JC: Number of pits--( .� : _:_:----Lining materia!_ RQ!;;A;.... Size: Diameter..`f/X-,_e.... Depth ..... �..�.............. Cesspool: Distance from nearelt well.................Distance from foundation -_-_ ------ I ...... Lining material -------------------------_ ElSize: Diameter -•-}....... ......................... Depth--_`�--------- - t------- --........ 3..... Liquid Capacity ............................ gals. Privy: Distance nearest well ................................... 1A ... Distance from nearest building_!._...........__._. ................ ❑ Distance;to nearest Ibt line....__._-_._ -...1 i re e) 0 W � 0 r Remodeling and/or repairing (describe)-------------------------------------•-----•-- ' ...... ... ------------------------ -•. ----- I (' . ..................... ---•-------•----...-----•--.........-----•--•---••-•------..........--------------- .------------- ------ •- . ---•-•-- . • ..........--------------------------------•--- - .......... -••--•-•--........................ ---------------------------------- --..................................... ...................................... -----•---•-------------------------------------------------I............................................................................................... -•----•------------•---•--- •----•--- ------ p.. 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 t (®r San Joaquin Local Health District. f ,p (Signed}... ---------_ .._._.. ....... r and/or Contractor) BY� ..............---------------------•--•- (r+Ie).-..._.. _ ... - (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on re9errs�e side). ( pp FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ............... -------------- DATE ------ 3-- REVIEWEDBY...------------------------------------•--.-•---•-•••-••---•-•• ...................:_._-----•-•-•---••-----.............. DATE....._.:.------------...................................... �y BUILDINGPERMIT ISSUED ----------•--- I.....---•-••-•-•-•--........-••.....-- ... ............. ............. ------------- DATE ................... =' ................................... ... Alterations and/or recommendations:......................................................._._..._._.__._.._..._....... .......................... G_ "...--- j?lT...... ci—..7p 61 K__ f�f=-------` `� .._ _.:............. ._.. ' I -G • mT t,........K .••............................-••........... -• •- .........._. ...----------------......................................................... ----•---•--------.........-------•--...------.......... -------------------------•---• .............................................-----• •. .`.. . t FINAL INSPECTION—BY ---- - .�% </�C • ......•... Date...........[/..._J` a. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California i 1 � J