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rUK UHAUIW USE: L ------ --------- ----------------------- -------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. __f 6.1.1 -: (Complete in Duplicate), :., ----------------- ------ --------- --This Permit Ex ices 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND :LOCATION__ /z._ '�v! � �� k — `~ ` - Owner s Name-------- -- �"y!�-""�-�Q-•----------- ------ � -- -. one---------•----------- - Address t` --- ------------=----- ----------------------------------•------------------ ------ ---------•--------------------------•--------- ------------------------ e' -------- Contractor's Name--- -�--._-.. ---- •-•-••----�-• �--�--•- " � : - _ - ---------------- Phone-------"--•----•------•-•---- ----- �i Installation will serve: t Residence Apartment House (] Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units:.'____- Number of bedrooms __ !~1(umber of baths I----- Lot size ____ } i€ - Water Supply: Public system "" pP y: y [] Community system ❑ Private Depth to Water Table __-__-- ft. \s 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 Construction: Yes No !'- - ❑ ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicsewer is available within 200 feet.)°�,. . j Septic Tank: Distance from nearest well._.___ . --Distance from foundation_______.___._._-_-Material___."__________ ___"-_ p:, r: 1 . . .- - - ----------- = No of com artments--------- --- --Size------------------------ Liquid depth_u # _ Capacity-------------------------- Disposalr k, Field: Distance from nearest well_.-__-----_--_.x Distance from foundation__________________ - Distance"to,nearest lot line________________� ❑ Number ofrlines-----------------------------------Length of each line------------------------------Width of trench'_____�-------------------------- pit: _-- Type of filter material--------------- ,._ -. - k -- -- -------- j Dep.''. 'filter-material----------------------- otal length----------------=------------ . r � Seepage Pit: Distance•,fo nearest well______ __-- __ ; _ _._Distance from foundation _'� __._ n o nearest lot line__S7.e .•• } NumEier of 05--------- __Linin m ---- ---------size: l r_ j_c�" -- . Depth-- ----�'-�--------- Cess --- Cesspool: --------- ! p h Distance from nearest well ______Distance from foundation_____._-_______-._- Lining material---._____.--.- ❑ Size: Diameter------------------------ ----De th_:. ----- f --- - --- -- -----Liquid Capacity----------------------------gals. Distance from nearest wall._______________. ! gals. Y -------------------Distance from nearest building - Distance'to nearest lot line__ _ .__ # t ------------------------------------------------------------ ----------- ---------- Remodeling and/or repairing (describe):_____.--_._ __ - --- -------------------------------------------------------- I------ -------------------------------"------------------------------------------------------------------------------------------- ------------------• -•--- € ff --------------------------7------ ------- ------------------------------------------------------------------------------------------------ I hereby certify that'l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------ -7-----------;j�X-------- - -------&Z-14-e " ------------------(Owner and/or Contractor) By:------ �-I'_---- - i - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can(bel placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED _BY____ � -- ---------------------------------------- DATE__(_ -------.-.-.--.-.-.-.REVIEWED REVIEWED BY----- -t------------=--------- ---- ----�- - - - - ---------- ----------- ---------------------------- ----- DATE UILDING PERMIT ISSUED ------------------------------------------------------------------- "`"" "pATE. �---r-4 ti, :. Alterations .and/or recommendations:__-'--------------"---_--_, ------ - --------- ------- ----- ----- --------------- ----- _____________ _ FINAL INSPECTION BY:" . :___-- -- Date_ -------------------------- �3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ES 9 REvl6 ED 3-'63 F.p,C C. Lodi,California Manteca,California Tracy,California 8-59 3M E