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FOR---- OFFICE USE: --------------- k ---- - -- - - APPLICATION FOR SANITATION PERMIT Permit No. ../V ..... ---------------------------- ----------------------_ i - ------- (Complete-in Duplicate) Date Issued :�:de,2 This Permit Expires 1 Year From 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 OCATI N ( ;�: . - ---- ---------------------------------------- Owner's Name------�AO V_ ----------- Phone_46(QZ03es_�s Address----------••---------/ , ...... ---------------------------------*-•-----•-----•------------------------ ------*------------------------------ 4Z I's --------I IN/C ------------- ------------------------------------------ PhonA&Pjaof Contractor's Name---------------ph ,7---- Installation will serve: Residence 'N % X Apartment House 0 Commercial El Trailer Court E] Motel F] Other E] Number of living units: -1-_.-_ Number of bedrooms I-.'Number of baths _1..._ Lot size - - ---'I / --Q---____-______________________ Water - - -------------Wafer Supply: Public',system 9 Community system E] Private [] Depth to Water Table facl ft. Character of soil fo'a depth of 3 fe6t: Sand E] Gravel ❑ Sandy Loam E] Clay Loam El Clay E] Adobe Hardpan ❑ Previous Application Made: [If yes,idate--------------------I No New Construction: Yes E] No)Q_ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well_________________Distance from foundation_____-_._____.._._ Material..______.____..._____._.___________-____..._____. ❑ ateriai---------------------- ------------------------- D r;*LSPO& No. of compartments------ -------------------Size-----•----------------------•---Liquid depth--------------------------Capacity----------------------- T - —_ 'Z Disposal Field: Distance from nearest well)URAlk.-Disfarice frorn-fbundaficn__/&_?----------Distance to nearest lot line,-S"r...... Number of --------Lengfh-of eline---V417- Widtk of trench._Zol!----------- ack fil------- -------- Type of filter material._k0_C,_K._____Depfh of filter mater;aI_._. ----------Total length---------------Imp ------ Seepage Pit: L Distance to nearest well_40,0 -DisfanceAom j?undatione / "-Distance to nearest lot line-- rx Number of Lining material--"C-N.__.Size: Diameter.__ p t h- -/ Q� ----------------- Cesspool: Distance from nearest. well-----------------Distance from foundation ------------------Lining material___._-_._.___..________-_____________ ❑ Size: Diameter.---I---------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. I Privy, Distance from nearest well.- .----------------------------------------- --Distance from nearest building-------------- ---------------------------- Fl Distance to nearest -- lot line- -- - ________-t Remodeling and/or repairing (describe):------- -- ---- ---------------------------------------- ---------------------- ------------------ - c------------------------------------------- ------------------------------------------------------------- ------- --------- -_ - - - ------ -------- - - . --- . ---- ------ ----------------- --------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------- -------•-------------------------------- --- -------------------------------------------------------------- ----------- I -- -- hereby certify Tfhaa prepared this application and that the. will 6e done in accordance with San Joaquin County ordinances, State laws, n rule and regulation f the San JoaquinC al Health District. P (Signed)------------------------------ --------- ------ --- --- ------------------------------------ (Owner and/or Contractor) - ---------- 2 ------------- - ------- ----- �i �s.ICL _buildings,- e_+r_____,_an 6.1' C - - - - - ---------------------------(Title]-----J� By:---------------------------------------4) (Plot plan, showing size of lot, locafi�n of system in re tion wells, buildings. efc., can be pla on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------ ---------------------------------- DATE-------- - -- REVIEWED BY------------------------ DATE BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------- ------------------------------------------------------------ DATE Alterations and/or recommendaf ions:" I------------------------ --------------------------------------------------------------------------------------------------*-------------------**------------- ---------------------------------------- --------------------I- ------ ------------------- -------1------------------------------------------------------------------- --------------------------------------------- ----------I---------------------------------------------------- ----------------------------I-------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ -I................ I----------------- ---- -- --------------------------------------------------------- ------------------------------------------------------------------------- ----------------- -------I------ ------ ............. ----- ---------------- - ----- ------------------------------- --------------------- -- -------- ---------------------------------- ---------- FINAL INSPECTION BY:-.--------- --Ja_�eDate------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P,CD.