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4vR vrril c USC;/ - ......... �^ 1 .--{�." APPLICATION FOR SANITATION PERMIT Permit No. 1�-„ - ------------------------------- ------------------------- (Complete in Duplicate) --- ---------"---"-------------------- - ------ --- This Permit Expires i Year From Date Issued Date Issued .44"~_� -3a 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 CATION-"---_-_-----��SL C -- --------- � FL% Owners Name------l- ---- ------•---------•-- --- - -------------------- Address. Phone.".. ------------------------------------------------ Contractor's Name c- "----- --••---•-'•. - - ------------ ' x�. -- —:: f_ Phone_" ,�___.7 3�d 9 Installation will serve: Residence ❑ Apartment House ❑ Commercial -------------- ❑ Trailer Court QK Motel ❑ Other ❑ Number of living units: -)';'-,Number of bedrooms_". Number of baths _- " Lot size ."020�� * Water Supply: Public system ❑ Communitysystem 47G Y ❑ Private Depth to Water Table f-O_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: (If yes,date-""-__-..- ------ No ❑ Adobe&. Hardpan ❑ I k New Construction: Yes k No [] FHA/VA: Yes. .'No �° 1 TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nea.res# well, .:.. Distance from foundation--/O_.-._-,-Maferiai--.. _ ksl. No. of compartmprftir: t. --------Size ---- # --- .. �: Q- -X -"-Liquid de - - - Cepacity,�/ U�GiS� Disposal Field: Distance from neerpst well: _f_Distance from foundation.--f0-"r__._Distance to nearest lot line"_ Number of lin es:v'F' ------Length"of each line------ --------- -- .. Type of filter material""" f Width of trench-.. '?' }. -"--.Depth of filter material""1 _ length """"" ----Tot Seepage Pit: Distance to nearestwell_ ;.,Q�_ .`® al ""_-"-." __!�__�_"-"__ � - - --- ,"""Distance f om foundation""/_- Distancetonearest )of line-_ Number of pits.: -�--.-_ Lining material-. = ----- Size: Diameter. �� , i ------ ---- Cesspool: Depth"_.-v S`. 4 ---------- Distance from nearest well__"-""""_- Distance from foundation.--"----------------Lining material-----_-.-.___"-__ ❑ Size: Diameter =- Depth - - ---------------------------------------------------Liquid Capacity Privgals. Y� Distance from �Barest .wail •-.�--.";__. ------ ------------------------"."Distance from nearest buiidin ❑ Distance to nea�res#.lot line.- } g . - �. --------•---- - ------------------- Remodeling and/or repairing (describe)------------------------ --------- -------------------------------------------- hereby certify that Ihave--prepared this application- -- and tha+ the wor-------------------------------------------------- ----------------------- ------- --- j ordinances, State laws, and rules and regulationof the San Joaquin Local Health District.be done accordance with San Joaquin Caun+y E (Signed)------------------ ------ ---------------------------------- -----(o caner and/or Contractor) BY: f r �L-- ------ eon � (Title). --- (Pio# plan, showing size of lot, I a+ion of sys�Fem in relation to wells, buildings, etc., can be la p ced on reverse side). FOR DEPARTMENT 115E ONLY E APPLICATION ACCEPTED BY------".- _ f l REVIEWED BY----- -------- --- ---- -- ----------- --------- -------- ----------------." DATE----- -- --- ---------- -- -`� - DATE---- ----- BUILDING PERMIT ISSUED -------------------------------------------- DATE _ ." DATE --------- ------------------- --------------------------------- Altera#ions and/or recommends#ions:.-"__ JI -- _ fX r-== 6 "" j�.� ---- --------------- -- -- -------�-�-• -= �-.� t•-LAK.-. ---�---- ------- -- 3 ------------------------------------ - ��.r�t� _ L ------- ------ ----- ------ ------------------ ;;�:-:";� :�-�- ------------ ------------------- tit 1 -------------------------- -------------------------------- FINAL INSPECTION BY:..-._-.�,-3- � ------- -- -------- - - - - � - - -- Date- --- ------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California '' ► ;y Tracy,California