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FOR OFFICE USE: ------------------_.---_-------___________-____-___-_ APPLICATION FOR{. SANITATION PERMIT Permit No.,�__.�� _. ------------------------------------------------------- (Complete in Duplicate) Date Issued ----------------- ------------------- --------. ----- -- This Permit Expires 1 Year From Date Issued Z0 3 _(&a�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 compliance with County Ordinance No, 549. JOB ADDRESS AND LCUfCAsTI�N � `�� a- ze-----.S'TC G/i�.ti /��4�•f��f ,1``� : its` p d Owner's Name------------ J.. !7 0---------- -------------------- Address --------- Address7-^ Y 1 �� r�/ 7:v�, T -----------------------------------------------------------••------------------ f__._ Contractor s Name--- ---•--- rvs.J -------------------------- Phone----------------------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [-I Other ❑ Number of living units: __/__- Number of bedrooms.. Number of baths -A Lot ti±e -------��G.'_L�?4�______________________ Water Supply: Public system E] Community system El Private ® Depth to Water Tablle AP-_ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan Eg Previous Application Made: (If yes,date----------------___) No Z' 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_________________Distance from foundation-------------------Material----------------------- ----------.-.....___--__. ❑ No. of compartments--------------------- ----Size--------------------------------Liquid depth-------- ------Capacity_-.--_-___--_-_----_- Dis®al Field: Distance offrom lines eare� ±ell.-��i�-.,-Length of from each line--,/-5--! ---------WidthDistance ofttrenchnearest��e-__`��_�__: p I `xType`of`filter`material1 : Depth of filter materia!_� _��-______Total length______ � ' -f. /y7 Seepage Pit: Distance to nearest well--- -V-----Distance fr founddtioR__/__-t•.i!______--_D' t n�e to nearest lot line.__ �_�__ �+ l Number of pits------- ---------- ---Lining material__ > A= _Size: Diameter-----" --------------Depth-----,V.-------------------- Cesspool: D tence�f earests`well:____� --Distf Crfrom foundation------------- -----Lining material--.-.--_____-------.----.-_-_____-.__. ❑ Size: Diameter--------------------------------------Depth---------------------------- ------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____ ______ 7__.____ ----------._Distance from nearest building___'---. ---- ] Distance to nearest lot line----------------------- ----------- ------ - \ �! e� E Remodeling and/or repairing (describe)- ----�- •-- ---------•-------•---------•�f�-�/1V�S-----��>��------------------------- ----------•-•-----•------------•---- ------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------ �.` 11 ----------- ----------------------- --------------- --------------------------------------------------------------- ----- ---------------------------------------•--------------------- ---- ` M ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I haveprepared this application and r.th work will be done in accordance with San Joaquin County ordinances, State laws and-r les.and regulations. of the San J tin LocalfH6a.lt0isfrict. f-e (Signed) / - t_ss ..-.. -- �---------- �_ .e. nd or Contracto By:------------- = �fr - ------------------------------------ ---- -�; ------(Title)--------- ....----...... ------------.. (Plot plan, showing size of lot, locafiielation +o wells, buil dings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY -�� APPLICATION ACCEPTED BY--- ---- - -- -- --- ---------------------' ------------ DATE - - ----------------------------- REVIEWEDBY--------------------------------- - ---------------I----------- -----------• DATE------------------------------------------ ----------------- BUILDING PERMIT ISSUED----------- ------f--------- --------- --------------------------------- ----------- ----------- DATE---------------------------------- -------------------------- Alterations-and/br-rec rnendati ---- ------------------------------------------------------------------------ �t ^f 6 i� -- ------------- ---------------- ---------------------------------------------------------- - ------- --- --------------- ------- .,'; -- =- --------�- ---------------------------------------------- -------------------------------- ---------------- . � -i-- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Ti FINAL INSPECTION BY----- . ---------------------------------------- Date------ f - r---------------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.