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J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No...1.� ..%. 3 ............................ (Complete in Duplicate) . Date Issued ........1- ..................................................... .. This Permit Expires 1 Year From Date Issued o f l — O Fd --s / 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 co m liance with County Ordinance No. 549. 2P fl Pa JOS ADDRESS AND OCATfOi%/.r,1%?�t�b?khc.+�i�E....: +~- _... / a . - � Owner's Nam 2 t�? . L�-� �-R-d'.....z........................................... Phone............... 0._.._._...._.. � .. . ........ Address. �Q.!...'e �7.r%r....�....� -ear:.-��'..-Q�-!....t.......................................... ....................... �.'.. Contractor's Name......._4% .... ........ l Phone__...::....................... . ...A...... .t...... .. .... Installation will serve: Residence ❑ Apartment House ❑ Commercial 7�Trailer Court ❑ Motel ❑ Other ❑ Number of living -units. _---:. Number of bedrooms :r'~. Number of baths ..t'Lot size.....�t✓��i.- ...:................ Water Supply: Public system ❑ Commuriity system El Private Depth to Water Table ........ ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe,[] Hardpan ❑ Previous Application Made: (If yes, date ........ .... ..} No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: d (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ................. Distance from foundation.................. Material................................................ El No. of compartments ................. ....Size ................................ Liquid depth . Capacity •� r � - Disposal ield: Distance from nearest well .... &........Distance from foundation.. /. .� ��..::Distance to nearest lot line ... S. ...... _ Number of lines __.._......._....� y� Length of each line .!.... E? ....a.... Width"i;f french .., :.. �.. Type of filter material.. TI: Y.�..r........Depth of filter material......-_,� .........Total Length.._...... f .:.... .:................ r' Se�pege—Rr#: Distance `to fpearest well......%C?� .._-Distance fromfoundation.....�:4I_...:....Dot�+a/�ncle toynearest to-ne.—r,!...... �j Number of ry '/..... ..Lining material..._re Size: J.../t..1.f?. Depth_...�lf.:.�... ..... ,....... Cesspool: Distance from nearest woll..... .......... Distance from foundation ....._ ;.`:`::...Lining material..........................�'....p� 'T... i ❑ Size: Diameter......................................Depth............................. •....,.._........liquid'Capacity............. .._ .. _gals. Privy: Distance from nearest werl............ .............................. Distance from;A*riW building.......................................... „Q ❑ Distance to nearest lot line.. .............:........ �'^ . �^ i,. . Remodeling and/or repairing (describe):........... -�t lT.... G� / <t._._.l" !ter. / ............................... ...... O Y '� '4 .: " i ................:%:f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San.Joaquin Local Health District. t ................ `t .. ........ .... _............ -and or Contfector (Signed) ...:......... ...`......... .... ..... _ � ..tree � ) By: ......... _/a,iu...... _....r..... Title '% Z (' ).............................................._;. . (Plot plan, showing size of lot, location o system in !,tion to wells, buildings, efc., can be placed on reverse side). ► FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... C:..7..:.. .............................. ................ DATE.. .. ........................ REVIEWED BY ... ........................................ ............................ ...... ....................... .... . DATE.......................... .............. .. ................. BUILDINGPERMIT ISSUED............................................................................... ................ DATE ......... ........... ................................ Alterations and/or recammen Qfi ns:........ .........................•. ...................................................._...._...........•..........••.......................... 9 .r'.- �...�.��.".. -r ..: �-��....C>j..`........................r ................................................................... I ................. ................. .......................................... .:.............................. ................................. .................................................................................................................................................................................................................. t FINAL INSPECTION BY:........ .'./ .... Date. '_'/ :,f......... ............... .. SAN JOAQUIN LOCAL HEALTH DISTRICT + 1601 E• Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wast 91h Street' Stockton, California Lodi, California Manteca, Californla Tracy, California E3 9 REV15C0 8.99 3M 3`63 F.P.Ca.