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F�BICE USE: ! Permit No. -- •--- ------ _ -------------------- APPLICATION FOR SANITATION PERMIT --------------- - --------- (Complete(Complete in Duplicate) Date Issued __-./�--Z-��,-•�g ----_._--�,_'_ This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#all the work herein described. This application is made in 6 mpliance with County OrdinancefN . 549. JOB ADDRESS D LOC�TION �----- �---------------------------------------------------------- -- -- ----- ----- ----- Owners e ------- t ----- - Phone. _ �(� �'� Address 4_9 -----------------------------------------••--------- !' - ------- ---------- --- t I A - 4773.991 Contractor's Name- =(- 4 Phone Installation will serve: Residence Apartmen use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_- __ ber of bedrooms __v- N -_L umber of baths __-_ Lot size _//- ---�-- Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table;(Q - ft. Character of soil to a depth!of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:; (if yes,date..--..-_--\---- No ❑ New Cons+ruction: Yes ❑ No Clay Yes ❑ No ❑ } I' t TYP5-Cli INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep ' , Distance from nearest well_________________Distance from foundation____________._____.Material---.---__---_-_-------_ ..__-____- No. of compartments----------- ----------_--Size------•-------------- ------- -Liquid dep Capacity Q i Di I lei: Distance! from nearest well1i 1`111iiDistance from foundation___ - 1J_-_----Distance to nearest lot ine__ Numben of lines----- -__ ---- - -Length of each line n---'e--- -�R.Width of trench-- - -- ------------------ I p 1�, .Total length---------------- � ------------ Type of,filter materi De th_of filter material_.----. _ i F Seep ge Pit: Distance to nearest well- �--__Distance ro;foundation__ {_ .___._.Distance to nearest lot line--n ---• I Numbed of pits----� --- -------Lining material- -----_.Size: Diameter. or--_Depth-.�G -------------- --- Cesspool: Disfance from nearest well-----------------Distance from foundation-------------------.Lining material---_-------------------------gals. Size: Diiameter--------------------------------------Depth------------ -------------- -------------- --------Liquid Capacity 9 0 Privy: Distance from nearest well------------------------------------ ------------Distance from nearest building-------.----------------------------- -- ❑ Distanc -------------------- ----------------------- e to nearest lot line--------------------------- ------- ---------------- ----------------- -------------------------- - - II Remodeling and/or repairing (describe)---- -- --------------- - -------- ---------- ---------------- ---- -- - ------------------------------ A• II: - - ---- - ------------ ---- --- ------ ----------- -------- �� --- ------ --- IM -------------------------- ----------------------------------- ---------------------------------------------------------------------- I hereby certify that Iahave prepared this application and that the A will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i - ------- �Contractor) 11' S�.__P7nC__-T NK--SH:RV-�E----------- tTitle) BY= (Plot plan, showing size of 1otiFl3betnli4t-�el �l�rt to wel , buildings, etc can be placed on reverse side). aI FOR DEPARTMENT USE ONLY `" - - DATE---- __ APPLICATION ACCEPTED BY-.-----.--- ------ ------ ---------- ------ -, --------` DATE --------------------------------- Ili ---------------------------------- i3ll LD NG PERMIT ISSUE---- DAT ------------------------------- ------ D------------------------------------------ --------------- Alterations and/or recommendations:__:........ .... ..:..... ... . -� _ I .:, 11 ------------------- ----------------- FINAL INSPECTIBY:.---- ..._ - Date.... - ------------- ----- --------------- ON a SrJOAQUIN LOCAL HEALTH DISTRICT 1601 R.Hazelton Ava. 300reet 124 Sycamore Street 205 West 9th Street 11 Stockton,Californi Lodi,California Manteca,California Tracy,California