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FOR OFFICE SE- -------- ?�"� f -- -- ----- ------------ -----------------------------------------------------"--- APPLICATION FOR SANITATION PERMIT Permit No. ,3 --------------------- it --------- -------- (Complete in Duplicate) Da+e Issued ----/----------------6--- __._ ._-._.____._._____ _ ___._____:._...__. This Permit Ex fres 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 ANpOCATION..��____-- ------1n -----•_---" - - --------••---•--------------------• ---• --••-•------------•-------------------•-••---- Owner's Neme- 7 `- —------------------------- Phone.... 7 U. r7 s Address ------t -------- Contractor's Name---------------------- •- _ ------------------------=------------------------------------------------- PhoneH. VS4_1W_W----- Installation will serve Residence Apa�frment House❑ Commercial E] Trailer Court ❑ Motel [] Other ❑ -Number oft;living units: __/___ Number`of b*o9ms ../-. Number of-baths ._Z__ Lot size _!G?Q,tY_ --------__________________ Water Supply: Public system V_1Communitylsystem�❑ Private ^ -Depth to Water Table Character of soil to a depth of 3 feet: ;.Sand ❑ ''G elm❑�Sancly„Loam.[D Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------------- } No P?�New Construction: Yes ❑ No FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Ta k: Distance from nearest well ___" --------Distance f;om foundation__le_______Mate�ai__.[s_l ,f`` .-________.__-. No. of compartments___ .. Size _, ._ Q.-f :-Liquid depth--- ----------Cap acity- =�� i l tri i _ ------ Disposal Field: Distance from nearest well___=......Distance from foundation___AK........Distance to nearest lot line._4__.._ Number of lines-------- _--L_-- ___---_ Length of each line_�___ �� Width of trench---a��._,_______________________ Type of filter matteeriial_ Depth of filter m sal" � �`"`.___Total length------ ......._______________�_.__ Seepage it: - Distance to nearest well----- --------Distance fro folation;:lQ.._.___.Distance to nearest Int line- un,, Number..of pi#s----- material.--.'- Diameter --'.--_______________ P `'61,_ a" ll Cess❑ool: Sized Diameter nearest well -----------De��h'Distance from fo�anon------�--- --..LjigUl�imat�riaL____-_•------_-_----•-_•-••----___--. .' ____._____Distance from,eaest�bu.Cbpacity... ..:: .................gals. Privy: Distance from nearest well------------------------------------------------- 1 ilding------------------ ._---------------------- F1 _---------------. ❑ Distance to nearest-lot line________________________ y tV rk ----''• --- -------------- Remodeling and/or repairing describe):_.____-______ ------- _--..... `k ---------------------------------------------------------•--------_-------..-..---•-•---------------------------------------- - lE I I hereby certify that] have prepared this application and that the.work w.ill'be done in' accordance with San Joaquin County ordinances, State laws, a d rules and regulations' of the San Joaquin Local,Health District. Ar "!T � •rv- Ie�Y -- r Contractor - (Signed) 4 ) By:----------------------- (Title)-- ----- ---------- (Plot plan, showing size of lot, location of cyst n relation to wells, buildings, etc., can belaced on reverse side). ,eell n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- y. - DATE-------- '----- ;`-------------- `REVIEWED BY------------ ---------------------------------- -------------------------- DATE------- --J--------------------------------------------- BUILDING PERMIT ISSUED-------------- - DATE._ ----------------------------------------- •-- ---- �. Iterations and/or recommendations----------------------------------------------------------•-----•-•-•----• -------------------------------- ---------------------------------------------- A, , ,I ....................... -------------------_----------------------_------------------_------------------------------- y i -------------------------------------- -----....---------------•----------------•------ ..._.. ------------------------------ :�- ------------------------------ - --------------- --- ------ - --------------------- - ------ -------•--------------------------- ------- ----------- -S ✓ /_ ------------------------------- FINAL INSPECTION BY--------------- ----- ---------- -------------------- Date---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street-�,; 124,Sycamore Street,' 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9-9 REVIBEo e•59 F.P.co.zM 6.6c ` .i