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/�wR vrrriik-t urt ---- -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .P_a__ :3 - ------------I---------- ---------------------- -------- (Complete in Duplicate) f This Permit Expires i Year From Date Issued -- -------- -- • --- --- . Date Issued 7__.h3 � 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 complia6ce with County Ordinance No. 549. JOB ADDRESS D LOCATION_ yj_""((J Ct� l -- Owner's Name __ JS ti- Phone__ p.--- Contractor's Name - `._P �- one � �o — -- /'�'� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mil Other ❑ Number of living units: __�___ Number of bedrooms —14 Number of baths ,� _ Lot size �' -- ------------------------ ---------------- Water ' Supply: Public system ❑ Community system ❑ Private k Depth to Water Table 7J ff. 4 Character of soil to a depth of 3 feef:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe,t Hardpan ❑ Previous Application Made: (If yes,ldate._...---------------) No 0 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundationEl __Material--------------------------------------------- ---- No. of compartments --Size------------------------•-- .-Liquid depth----------------- --------Capacity--•------------------- Disposal Field: Distance from nearest well_____________ Distance from foundation--------------------Distance to nearest lot line ___-____._. ❑ Number of lines- --------------------------------Length of each line------------------------------Width of trench Type of filter material__________________--____Depth of filter material__-___-_ I ----�- ------Total length--------- ------------------•---- Seepage P" : Distancq tp nearest well__&0._._-...Distance from fun ation__ ______________Distance to nearest loft line____ W Bill Number.ofits. p - -------Lining matenal�►+�-r- ---- -- Size: Diameter-----s3 I - � ------ `� .......Depth------ _-�-- --------- � Cesspool: Distance from nearest well-----------------Distance from foundation------ material___.__...__---"___---- ❑ Size: Diameter----t--------------- ----------------Depth-.--------------- --------------------- � - ----------Liquid Capacity---- --------------------gals. Z Privy: Distance from nearest well ________________._____ ._._ _ ____________________Distance from nearest building + r ❑ Distance to nearest lot line - Remodeling and/or repairing•describe):_______ ---- �--�-�^�----- - +3 __-�"�;---•-. ,�------ -------- -----•--- -- - ----• •sem �. I ---------------------------------------------- ------------------------------------------- • --- a, ----- --- ------------- ------------ -------------------------I----------------------------------------------------------------- - ----- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf" fe laws, and rules and i r gulations of the San Joaquin Local Health District. ��-- (Signed} -------- -------------- ----'`�- -r --- --------(Owner and/or Contracforri BY= ------------------------------ -------------------------- --------------------- Title jo-_. -- - - ---------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------ DATE------------------- - I --------------------------------------- lEWG E - I IS --- ---=-I----- ------------------- DATE------------------------------------------------------------- - ------------------------- BUILDING PERMIT ISSUED------------------ -------------- �------- ------ --- ------- - - DATE- - ------•----------- --------- Alterations and/or recommendations:_%7v _- � ---.,r ejZ.. -- - - ------ - --- ~---- ---------------------- �'T'_ ----- �r1--- - /�__ ,per ---------- - - . ---------- ----------- - , ----- FINAL INSPECTION BY:----- --- ------ - ------ Date ----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1b01 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California - Tracy,California F.P.E O. ,�,