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FOR OFFICE USE: it._.........10.. �r-1.0....--. APPLICATION FOR,SANITATION PERMIT Permit No..l.L�EJ.... ...... ........................... (Complete in Duplicate) s A�— _.._.._.... This Permit Expires 1 Year From Date Issued Dete issued ......' Application is hereby made to the San Joaquin Local Health District for e permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION].--------.-.,_?�r-.----/_,!,1.C_...-.._.._.P.-_._..---------------•--._- Owner's Name `-?'.-----•--- .--•--_. .........--•-•-•--••----.._.. Address....... . S 1..._Q.4,47----------------------------------------•-----------------------------------------------------------------••------ Contractor's Name---------- ---------- �!QrB/,S'G`l� `�...... Phoney 2.�__1?11 45! -,Z. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1 . Number of bedrooms _'y . Number of baths ._-1_ Lot size ------ ................... Water Supply. Public system ❑ Community system ❑ Private Depth to Water Table6 .. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam U Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date._ --- ----- No Q- New Construction: Yes ❑ No [—FHA/VA: Yes LJ No [�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well ................. Distance from foundaiion------------------- .Material ---- ....... ........................ ❑ No. of compartments --------------- -.......... Size -------------------------------- Liquid dep.th... .._........ . Cdpacify._ ................ / Disposal Fiea Distance from nearest'well. Distance from foundation --- %0..._ ..... Distance to nearest lot line. ZNumber of lines...............l. Length of each line..____Width of french --- ar .._`!_...........___.. Type of f;;.er materiel... r-��'r .___Depth of filter material... AP.............Tofai length .... i Secpag �P,iitt/ Distance to nearest --------- Distance from foundation _.._.AF .__.Distance to nearest lot Iine_�'r___-_._ 7 A Number of pits..._..._.......... Lining materiaLAe<.ck...... Size: Diameter.__d_-'.'4...---.. Depth- ..-------•.--_- Cesspool: Distance from nearest well ................ Distance from foundation.................... Lining material. ........................ Size: Diameter-------------------- ❑ ------------------Depth ............. ........ -.................. --•- ....... Liquid Capacity._------------.....ga s. Privy: D;stance from nearest well ............... .................................. Distance from nearest building............. .... V' ❑ Distance to nearer; lot line-------------------------------------------------------------------------------------------------- ._. _ ... W Remodeling and/or repairing (describe):_.___ '___..../ __.. '1 -ST/. /t r' - ....... .4e .......................... � -------------------------------- -----•---------- ...........-•-----•..._._...-•-•---•-•--••----...---.....•... •............ ............................ .. _...._._.................... \l ' _ ...... ----------.................................................. ................ ....... ...... --..... --.-........... . ......_.............................................. ........... .------- CSS --------- ----------------------------------- -11.-- --------------- •------------------ ....------- --...................... ..------------------ ------ I 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 r end regulations of the San Joaquin Local Health District. (Signed)-------------- ---------- /' .! ..:=�:------- ��-------•---•-•-•--------------------------�_10w�nand/or Contractor] BY=- .... __ --------_..�1.cion a�r.''�"-----------•--------------------------------- ----(Title)--..(Plot plan, showing size o tem in reietion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.._......------------------ ---- ----- ------------ . .......... _ DATE - �� - = 's- ........................... REVIEWED BY .. DATE ................................ BUILDING PERMIT ISSUED ----------_----- ....................................... ...•. ------ •-- DATE ................ _.................. ----.................... Alterations and/or recommendations: ............. _..-•.............. .... .0 .J . ..._. .�^---. _ _ _ _ L .._. ... .... _.. _... _.. ..... _. ..._ �__ ... .... _... .. ......... .. ....... ........... ............ ........_ ..------------ ....................... ................................................................ ..------- ............................... FINAL INSPECTION BY-_ --- ................. Date ....................... ------ ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 9. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California r.P.Co.