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-- -' %0 r FOR OFFICE USE: 4 ,: /i APPLICATION FOR SANITATION PERMIT Permit No. .,5. g- )7.- fci.-- __ ----__.-_ _--10 (Complete in Duplicate) Date Issued 40__'4 .____:._y=- This Permit Expires 1 Year From Date Issued ------ ---------- - ------ - Applicafion 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 Ordinanc No. 549. 4 ---------------------------- ---------------------------- ` JOB ADDRESS A D LOCATION-___f-. ._ ---5` --------- Owner's Name - ----------- -------------- ---------•---- ---- --------- -- ------- ----------------------------------- -= -... Phone--- 7�--��/f l - - Address 21 ----------------I------------`----------------------------- --------...-------------------•----..-_... Contractor's Name-------------------- ------- ----• -- -•-- - - ----- Phone.- � '_-3/�------ Installation will serve: Residence 'Apartment House E] Commercial ❑ Trailer Court [I Motel El Other C1 Number of living units: _-1- Number of bedrooms __y-- Number of baths Lot size _11— -------1 r� Water Supply: Public system ❑ Community system [Private ❑� Depth to Waterjable *O,ft. � ( Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff---Hardpan ❑ Previous Application Made: (If yes,date...___--- ) No �ew Construction: Yes �o ❑ FkA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:'V ` (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Tank: Distance from nearest.welL� ---------Disti�,e from foundation_ L?- Mate�+al. � 1 No. of compartmeiit's.�--.c------- Capacityay - Size `S X1 Liquid depth-----/-------- -. Disposal Feld- Distance from nearesf,well-!�P------ --Distance from foundation--,Jlo_-'.'-_--_.Distance to nearest lot line--------�.- _ Number of lines--,/f__ Length of each line�l$`llS_S �Width of trench-___-----. -`/-��---------- 1 Type of filter material--S_!�7G�1t�-De th of filter material--- 9 Total length -�--ate---�----------------•---- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line----------------- ❑ Number of pits-----------I----------Lining material------------- ------- Size: Diameter- --------------------Depth------------------------ ------ Cesspool: Distance from nearest well-----------------Distance from foundation.-.------?._--.---.Lining material----_ _----_---.- -------- Cesspool: ❑ ---------Depth-------- ----------------- ` -- Liquid Capacity----------------------------gals: y C Size: Diameter--------- ------ ------- -- ------ ------ - 1 Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------.------------------------------- --------------- ❑ Distance to nearest lot line----------- ---------------- =`---------------'-------------------------------- a Remodeling nd/oor r - airing (describe :--� - - , ------------------- '4D . r - ---- -- ---- --- - -------;--- -------------------•------- --------------------------- � a I hereby certify that l have prepared this�a�plication and that the work will be done in accordance wifh San Joaquin County i \ ordinances, fe laws, and rule and gulations of the S Joaquin Local Health District. Owner and or Contractor) (Signed)-- ---- - - ----- ----------- -- .- F --------- -------{Ti+le)----- - ---- ------------- ------ - ---- ---- -- --- r (Plot plan, showing size of lot, location of system in relation,to wells, buildings, etc., can;be placed on reverse side). f FOR DEPARTMENT USE ONLY c a ---- DATE---- 3�." - ; APPLICATION ACCEPTED BY_. ----•---------------------------- --- IREVIEWED BY--------------------------------- - ------- - ------------------------------------------------------------------- :DATE. = ' BUILDING PERMIT ISSUED----------------- ----)---------------------------------•--------�- ------- ----------------------- DATE---------------------------- Iterations and/srec mm d.ati s -`Yva'-'s7..- `-� - -- - -------------------------- ----------- ----------------------------------------------------------------------------------- ------------------- ------ -------------------------------------- - ---------- - - - - FINAL INSPECTION BY-__--- -- -- --------------------- Date.- .----------h SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o.