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U7tr ;.. t I = ------ ------ '`�__ APPLICATION FOR SANITATION PERMIT Permit No. .f -......-....... ----------- �----------- --- --- -- -----•----/ �� (Complete in Duplicate) ---------- ----------- ------------ --------------- -- This Permit Ex fres I Year From Date Issued Date 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----_------rl /«- `=-&,�/7/S �* -------------•-------------------------------------- -- •-- - --- ---•------- ------- Owner's Name------------ ( (. _ _� Address-------- ------------------------------------ Contractor's ------ ------------------•----------------- Contractor's Name--------• �atl .1 ----------.� /` �` r ----------------•- ----------------.--- Phone. ._ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units. ---- Number of bedrooms.9__-- Number of baths J___ Lot size -__ Water Supply: Publ c system-B—Community,system ❑ Private Z Depth to Water Table _!� ft. Character of sail to a depth of 3 feet: Sand ® Gravel ❑ Sandy Loam❑ Clay Loam 0-1Clay ❑ Adobe ❑ Hardpan ❑ Previous Application y�lf es,date---- .J No ly New Construction; Yes ❑ No Q�FHA+/VA: Yes ❑ No C]-- TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic taEnk or cesspool permitted if public sewer is available within 200,feet!) Septic Tank: D' Vistance from nearest well_______.--_--__Distance from foundation__________._._.__!Material---------- ______________ - ....�...._,_„�,_ ...,..... ❑ No. of compartment_s----------------------_--Size--------------------------------Liquid depth-------I---------------Capacity------- Disposal eld: Distance-from nearest well, --r.-_Distance from foundation___),�__'_o------Distancd1to nearest lot line_j`a_---.,, Number of fines----1------------- ------------Length of each line---1- _'---A------------ � �� p 9 Width of trench--- 9._,< - �V Type of filter material___ i�� jC'--Depth of filter mate ria ,--__--=Total len th___ _ -- Yp 9 -�` ------ .,.....�..�._.x 11 Seepage Pit: Distance to nearest well-,_,270-_�_._.---Distance fr m foundation- - -_;._ __.Distance to nearest lot line__._�d ®" Number of pits---._/--------------Lining material_z/c'nf' ---Size: Diameter_-a_l---_----.Depth--.. ""- -------------- \. Cesspool; r' "'—uDistance`from'nearest'welL____-___.._._-_Distance from foundation.............. .....Lining material-------------__._--_ ❑ Size: Diameter----- -------- Depth Liquid. Capacity._ gals. Privy: Qistan'ce.A omanearest 14---------- f � �, -------------------------------Distance from nearest building--------------- -- ❑ Qrstance to nearest lot line..______________________________ ----- Remodeling and/or - - . __ _ F_______ ______________ ------------------------------ I I --------------- "%rC 4 ._ ------- ------------- ------------------------------------ .. .b. € -. •- -- - ---------------•----------------------------------- P t pp [ --------------- --- -------- -- g ------- ----------------------q---------------------------------------- • --- _- I hereby certify that I have pre ared this application and that the work wrll'66*don6 in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f �„s r {• (Signed / 1�^ J- _��,�-�� `�-F"_--------- ----- - �; - V.(Ow and/or Contractor) { p By:.. �`�" '-z -------- ------ -- ----------------------------- Title n r { 1 ------------------- ------------ Plot Ian, Showingsize.of lob, 10 'on system in relation to wells, buildings, etc., can be placed on reverse side). i t FOR DEPARTMENT USE ONLY 1# APPLICATION ACCEF ��, + PTED BY--------- l�� ---------- - -------� ------ 1 ...- ----=-----•--- DATE-------�-n�l�--------�..,r' REVIEWED BY ------------------- -- --- --------------- ------ --------- - ------------------------------------------ DATE-------- ---- ------------- - � BUILDING PERMIT ISSUED--------------.----------- DATE.-------------------.-- Alterations and/or recommendations.__..._ 7-1---- -.-4—:--.: -. L ------------- -- -- � ----- �---------- �. _ - ° '� '"`+ ---------------- -- ---------------- r--- = ---- -!�---•--------------------- --------------------------------------------------- FINAL INSPECTION BY:_ ----- --- /� a ----------------------- Date---------- ------ ----------- ----------------------- AQUIN LOCAL HEALTH DISTRICT 1601 E.NoWlion Ave. Street 124 Sycamore Street205 West 9th Street Stockton,California rnia Manteca,California Tracy,California F.R.r o.