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r. -- FOR OFFICE USE: - -------------- -------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. �;__)............... ------_---------------------------- - r = - (Complete in Duplicate) --/d------ - -�� ------- -------- Date Issued �1 --------------- ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the $ari Joaquin Local Health District for a per.t it to construct and install thqwork herein described. s This application is made in compliance with County Ordinance No. 549. "�� 0Cr�. RV �� ly9AR1P+�51� JOB ADDRESS AND LOCATION-_"_ .F- -__. --•--- o - Owner's Name------- -/�-------J Phone.-----------------------•-----•---- I G` ` Address _ _ i-- l ,�------- a1t- ----•(--- ' ----- Phone------------------------•---------- Contractors Name--------- ------- InsfAla+ion will serve: Residence 4K--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I--_ Number of bedrooms __9—_ Number of baths Y--- Lot size ---------------------- Water Supply: Public system ❑ Community system ❑ Priva+eepth to Water Table f . w. Character of soil to a depth of 3 fee+: Sand ❑ Gravel El Sandy Loam El Clay Loam pg ''fflay ❑ Adobe ❑ Hardpan Previous Application Made: (if yes,date--------------------l No New Construction: Yes E] No 42-' A: Yes E] o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w IL_ �---Distance pm foundation _. fir `J�� _ Mate 'al._..__._�_/_ .- - -- No. of compartments._ ------------------Size ___X�� ---Liquid depth--- Capacity - _ .011 Disposal F• Id: Distance from nearest well.�w---- ._Distance from foundatian_ Q__.__.-_-Distance to nearest lot line_ ....- Number of lines----- ! - ---/-� Length of each line__-�S -.__ -----.Width of trench_________ ___________________ Type of filter material __ /�!`�'-De------ Depth of filter material--.��--------Total length��_-_=��_�--------- �e Seepage Pit: Distance to nearest well-- ;0__-._--Distanee from foundation-_-�V__�-V --_-_. 'stanSp to nearest lot �.---------.- i n� Number of its___-. ._ '''�in materia - p IFS' p F:g - - f4.5ize: Diameter.- Dept e?- Cesspool: Distance from nearest well___ : '_,_.....__Distance from foundation-------------------Lining material------------------------------------- . ❑ Size: Diameter- - ctr Depth --- .-Liquid Capacity---- ---- ----------gals. �.. ..., t{!6 Privy: Distance.from nearest well...... N"`;�------------------------------------Distance from nearest building---.-------------------------------------- t 4-----t Distance to nearest lot line.... -'=;s= -------------------------------------------------------- A J l - Remodeling and/or repairing describe :.. ,- --- - -- ------ --------------- e.. ------------------........----------------- --- --- , }, - - - - - -- ------------------------------------ ----------------------------------------------------------------------------- -- I hereby certify that 1 have prepared this application and that +he work will be done in accordance with San Joaquin County. dJdinances, Sta+e'ilawAarules and regula+ions o the San Joaquin Local Health District. ' ( '§ a 1� ---------- ---- ---- (�r Contractor} Q rte. S, 'ned) --------------- - -- ------ ` j - Title ._. By:�; ------------------------------------------------------------------- ` ( } ��-"` - .... (Plot plan, showing size of lot, location of system in rela+' o wells, buildings, etc., can be placed on reverse side}. -* n FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BYE-) = ----------------- DATE-------- O__ yl ( ::r-------------- . rREV[EWEDYBY. = = = ------------------- DATE------------------- ----------------------------- i� i BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.-------------------------------- ------ r Alterations and/or, recommendations--------------------- ---- --------------------------------------=------------------------------=--------------------------------------- -------------------------------------------- ---------•----------------------------------------------------------- ---------------- ---- - --------------------------------------------------------------------------------------------- -- ..----------------- -------------------------- -- FINAL INSPECTION BY:-- 7io �r/�P Date //----�~ -------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California,�,:r - Manteca,California Tracy,California F.P.00. 4