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ruKU"ICE USE: ------- ------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. - ----------"--""- """" (Complete in Duplicate) ' --- ,�- This Permit Expires I Year From Date Issued Date Issued - -_�6 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 com��11pliance with County Ordinance No. 549. r" JOB ADDRESS AND LOCATION---- --------------------U------CA/VII3R-I_D- " JTI'�RO ----- Owner's Name`-}I L LJ:Ps_--.-_-.--CC�-n!_.STR U CTI D-1.--._..-C---------------- - - - � - - ...... Phone Phone-•----Address-----------------63 2- = H-04rMAi------- = 4n6TN_ -p--1- - Contractor's Name----------F0 'LL�P I 1 ----- Phone ----- Installation will serve: Residence ±j— Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other ❑ Number of living units-.4__ -_'Number of bedrooms 3-- Number of baths 1---- Lofi ----------------------- Water Supply: Public system! �Community system ❑ Private ❑ Depth to Water Table/0- ft. Character of soil to a depth of 3,fee+: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ )Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ) No Construction: Yes �No FHA/VA: Yes s❑' 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 Distance from foundation--._1-------------Mater' No. of compartments--"__,�--------------Size--y ffl_XS.---Liquid depth---- � --------Capacity /_;ZP8---- Disposal Field: Distance from nearest well--�.�_._Distance from foundation+---/0---------Distance to nearest lot line-- �E' Number of. line's------- - - ---- - ----- ----Len fh cf each line_ Width of . trench--.-----_- f V ---------- Type of filfer matetial: iQ ---Depth of filterrate�ial-:"'-1Total'length ------_- Seepage Pit: Distance to nearest well----------------------Distance from foundation-j---_---__----.Distance to nearest lot iine.__ ---.--_----._ ❑ Number of pits-------------------_-Lining material------..--.-_---_.-_-_Size: Diameter_:_: ---------------- Depth Cesspool: Distance fom nearest weft-----------_---_Distance from foundation'_ -__-"."._.Lining material-".................... p r t-------- .Liquid Capacity----------------------------gals. ❑ Size: Diameter_ ---�--------------- - ----�- ----De Depth ---- --- -- Privy: Distance rom nearest well--_--------."______ Distance6f'rom nearest building_-"-----_--------._ ❑ Distance to nearest lot line-_.-._.__.." _---.-.-__-"-.__ -- Remodeling and/or repairing (describe -------------------------- - _--__.-----------------•-------------------------------- {------•_----_----___.----_,__-_------__---__-----_•.---.-----.----.------_-------.. ---•--------------------- ---------------------------------------------- ---- ----- -- ............................................................. ------- ------ ----- I he certify that I have prepared this application and +het the`work will'6e done in accordance with San Joaquin County ordinances, State-laws, and rules and;`r la#io of the San Joaquin Local Health District. I 5i ned - t { 9 ) -- - A _ /or Contr for) w BY----------- -----------------------------------'.'..- (Owner an : n wa�s --------------- ---------------------------------------------[ I+ } f Y g n (Plot plan, showing size of lot, location of system in relation wells, buildin s, etc., can 6e placed on reverse side). r FOR DEPARTMENT USE ONLY : APPLICATION ACCEPTED BYI...... .- .°---------_----------------------------------------------------------- DATE--- REVIEWED BY -------------------- -- ------------------------------- ------------------------------------------------ DATE--- ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE terattons and/or—recommendations:----------------------------------------------- - ------- ------------ 1a M r�; r t' ------- ----- ---------- -- FINAL INSPECTIO BY: --- ---- ----- --- --- Date----------------- ....�j(�. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.C C.