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OFFICE USE: � o v APPLICATION FOR SANITATION PERMIT Permit No_ __ ___ -- --------------- ----------- ---" } (Complete in Duplicate) .� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ------ 'Owner's Name k.__, i 1_._. _. t } � :_ _ ---------•- Phone �/. ------- Address------------------ Contractor's = .. �5 /-� /- _ ,CQ :-f S6:wle-- - -- -------- �l t � -. Contractor's Name = ------ -----� C-i Installation will serve: Residence Apartment House ❑Commercial ❑ Trailer Court-- Motel ❑ Other ❑ Number of living units: -_.Number of bedrooms _-'�s Number of baths __�.__- Lot size ____ w o.._ ." t Water Supply: Public system [ Community system Q Private ❑ Depth to Water'Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam ❑ Clay Loam•❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: (If yes date_.._-------}-------- i ) No [�L New Construction: Yes E] 'No % FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: f s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well--t-------------Distance from foundation---------------------Material _____-__.____.._______.____._._-____._____.____. 0&iS`f1fJ1 No. of I compartments-- -------------------------Size--------------------------------Liquid depth_-i-----------------------Capacity----------------------- Disposal ---- ------ ------- Disposal Field: Distance from nearest we1l.APP4n-Distance from foundation---.3B----------Distance to nearest lot line_-1Q__r Number of lines_I--_� �_�� -�_- - Length of each line f f�__._'Width of trench__`!--------------- Type of filter materiaLl-�___ Depth of filter material____-f-____ ._Total length------: E1______.___________________ �y Seepage Pit: Distance to nearest well__R &A/e,_____Distance rom ; oundation____3W__- _f -___.Distance to nearest lot line_ Q-�__._ �-- Number of pits-_�f1!tl�._G� --Lin ing material___ ° _ --size: Diameter--_±3 -. ........Depth Z.�- ---_____._ Cesspool: Distance from nearest well+'_______________Distance from foundation---------------___-Lining material ..___....____.__---._._________.__ ❑ Size: Diameter._-t ------------------ 1 16 1 A- Priv Distance from nearest well__'_____________ ---------------------- from neast Liquid Capacity_ _________gals. ------Depth--------------- y' rest building ❑ Distance to nearest lot Ione----------------- 1 - aeetl:Remodeling and/or repairing (descri4e):----- •GCvG / G-------- p -----------------= -- 1 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 la les and regulations of the San Joaquin Local Health District. J 1 t (Signed)_ t . 4 -- � --------- --- -- ------------------------ (Owner and/or Contractor) �j By:---------------------------�fj--- ------ ------------ -"------ = (Title) = (Plot plan, showing size of lot, locatio�l of system in relation to wells, buildings, etc.; can be plat on reverse side). 1 i } 'r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- F - ' DATE r ---------------- -. _ REVIEWED BY i-------------------------------------- -------- ---- - ------------------------------------------ DATE BUILDING PERMIT ISSUED------------------ --------------------------• ------------=:--------------------•------- DAME`--- - -------------------- Alteratjons and/or recommendations:!--------1-7/Z ._ f- ........ � --- - '« ------ � — ---------------------- - -- � 2 _- GC- �--- ------------ � --------- ----------"----------------- ------------- --- ------------ ------- .... FINA11 9NS PECTION BY: "------------------------- -- --- -------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C 0.