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----�S��R OFFICE USE: y --------------------------- -------------------- --------- -- - - ----------------- , 17 __ ____-----___ APPLICATION FOR SANITATION PERMIT Permit No. .... ....... • [ I]/ --------- --- {Complete in Duplicate) r r This Permit Expires 1 Year From Date Issued Date. Issued _ __ __ � VA/ppl cation is ereby ma a 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__ -- .-__-/ - -- / r;�� Owner's Name........... -- cQaS `_� .f7Cfl� -------------------------------------- Phone------------.---------------------- Address--�O-- �.. .5 -C�i/ d > d7•� C.1-1-------------------------------------------------------- Contractor's Name. _ ----------------------..-------- Phone... _=e4r9_1 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other §d0;4&A1t1 r Number of living units: -------- Number of bedrooms Number of baths -------- Lot size f____ _,� _�-!-.-,---___----_--- Water Supply: Public system Z C_ ommunity system ❑ Private ❑ Depth to Water Table 6-Vt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �lardpan ❑ u► Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ iCtDistanc� $roar fo nion____��_-___-__Mat erial.__Ca_d C`4s.e __.___.___.._.. ry�1/ i No. of compartments.. __________________Size _ _�'7� ( , Liquid depth _...._---.---Capacity__120- ----- t [� Disposal Field: Distance from nearest well_1��.__Distance from foundation---�.....__.-._....Distance to nearest lot Number of fines,,3Length of each line__?-_� Width of trencho2 ?�___._ _.-_ Type of filter materia .( ,A---.Depth - + 11 g �of filter material____.__/.. . .Total length -_7D___.___-_. Seepa a Pit: Distance to nearest well___M._-- . __Distance om foundation___ Distance to nearest lot line_----- Number of pits.---.--_--I..._.___Lining material_ Size: Diameter:_ �._ . Depth___ .r--------------- Cesspool: Distance from nearest well_________________Distance from f undation_____________-_____ Lining material------------------------___-.------_ ❑ Size: Diameter------------------------------------ -Depth------ --- -----------------------------------------Liquid Capacity_-----------------------•--gals. Privy: Distance from nearest well---------------------------- Distance from nearest building____-__----.---._----.-_--_.____..__-__--- ❑ Distance to nearest lot line---------------------------- - ----- - ----------------------------- Remodeling and/or repairing (clescribe), � � � ---- --- ------------------ ---- - -------------------------------------------------------------------- ----------------------------------------------- ------ --------- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------------------- 1 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 the San Joaquin Local Health District. , (Signed) �l � - }!'h - cL..}�.lf ----------------- ontractor) By:----------------------------------------------- ------- ------------------- - -- --- ------ - -- ---- - (Title)---------------:------------ ---------- - ---- (Plot plan, showing size of lot, location of system in rel on to wells, bui Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By--------------- DATE 6 ' REVIEWEDBY------------------- ---------------- ----------------------- -------- - ---- ----------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------ --------------------------------------------------------- DATE----- -----------------------=--------------------- After to and/oZrecginmenda atio s:_______ __,4Q, :-------- - ,er g ---------------�-�---------------------------------------------------------------- ------------- ----------------- -- --------------------------- -- ------ -------------------- ------------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY---------------- --------------------- ------------- SAN C ----------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 O. JJ