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----------- ---------------------- -------- ------------ ------- -----�----------------------- -------------- APPLICATION FOR SANITATION PeRMIT3�K Permit No. ----------- -------- ---------- ------------------ ------ (Complete in Duplicate) .......... ------- ---------- ---- ----------------- --- I This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for 'Permit to construct and install; the work herein described. 1, nce With county Ordinance No. 549. PERB - ---- ----------------- 0 Name-- ---- -- - Owner's ;W ---- ---- ---------- ------ ----------------------------------------- Phone.,- ----Address ---------- 1----------- ------------------ ----------- -------- ---—----t - -------- - ------------------ Contractor's Name-----% C& 27__4 ---------------------------------- .... Phone_ Installation will serve: Residence Apartment House E] Commercial 21❑ Vrailer Court E] Motel F1 Other E] Number of living units: Number of bedroom's _:�_ Number of bath's,-t-Y-2 Lot size 4Z__!---------------- Water Supply:- Public system El Community system UT"Private E] Depth'ito Waiter Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel C] Sandy Loam e"Clay Loam [] Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: ' (If yes,date____________________) No El New Conskc1ion:, Yes [B'No El FHA/VA: Yes P-' No ❑ —T-YPE40E-INST-A,tL-A-T-ION-AND-SPECIFICA'T'IONS--.--�;-�-,;---:=---:7�7. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---GIV-_-Disfance from foundation---- ------------------------ No. of compartments------Z------------- dept'h--- -----------capacity.-/'Z2 0A----- Disposal Field; Distance from nearest well---C7--IV.-.Distance from foundation.-..10___.. - Distance to nearest lot line___--5--------- Number of lines___-__.__ :5 __.__...__Length of each line_$4�'60S--�OWidth of trench.....—t"�46 Type of filfer materia V' QpO oUiJte,_,aterii�I----IT'1----Total le' r�gt rl Seepage Pit: Distance to nearest ve��---------------------Distance from foundation-----------........Disfance to nearest lot Ii ne- Number of pits.---. j-------- El -----------L�ning ----------------Size: Diameter---------------------- Depth---------- ----------- Cesspool: Distance from nearest well--------------- from foundation--.--------------- - Lining material--------------,--------:---:-------- Distance n S'Ize.'- Diameter-----------I---------------A -"-Depth------------------------------ ------- ---------�_�,�Liquid Capacity-------------------------- --gals. 0 Privy: Distance from nearest well------V i I I " f - --- --------- ------___________-----Distance from nearest bui�cling. - ------------------------------- ...... El Distance to nearest lot line---1.4 r 1. 1 ----------- ------- - I----------------------------------------------------------------------------- Remodeling and/or repairing (describer-------- ---------- ------A---------------- L -f� ------------------------------------------------------------- ----- eo - ------------------------------- --------------------------------------I---------- ---------i-----------------------------4-----------------------------------—-i---------------------------------------------- -----------------------------------------------------------I--------------=•-------=--------------------- -------------- ------------------------- --------------------------------------------------- ------------------------------------------------------------------------------------- -----------;------------------- ----I----- --------------------------------------------1------------- --------------I -i------------- I hereby.certify that I have prepared this application and,tk4af the work !1�i be,done in accordance with San Joaquin County ordinances,Zlal ; , and rul�sand reg 11affionstf,the San Jo quip Local District. .V .......... ............. (Signe --- ------- -- - -- ------ -- ---- ------- -------- -- ---------------------- --------jag;e,7,�Contractor) y------------ - --------------------- ------ ------------ ------- - ----------(Tifle)---------------------- ------ ----------- ------- ---- - - (Plot plan, showing size of lot, location of system-in relaH. 0 ells, buildings,? tc., ca I n be placid on reverse's"ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ --- -1�4 ---------------- -------- REVIEWEDBY------------------------- ------------------ --------------------I ------------------ ------------- --------------- DATE. BUILDING PERMIT ISSUED__________________ - W------ --------------------------%�--------- DATE Alterations and/or recommendations --- ------------------ -------- I . .. , - %_ ------------------------ -- ------------------,---_------------ --- - -------------------------------------------------------------------------------------------------- -------- ------------ ------------------------- ----- ------------------------'---------------- -- -------------------------P�---------- -------------------------------------- --------------------------------------------------------- -------------- ---------------------------------------- ---------- -------------------- ------ - --------------- ----------I------ ------------------------------------------------------- ------------------------- --------------------------- ----------------------------------------------------- --- --------- -------------------------- -------------- --------- ---- -- ------- - ------------ ------------ ----------------------------------------------- ---------------------- -------------------------------------- FINAL INSPECT Date-- ------- ILa.- 1� ........ . . /fil Y_ - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxolton Ave. 300 West Oak Street 124 Sycamore Street205 West 0th street Stockton,California Lodi,California Manlii;: California Tracy,California