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rvR ,jrrit-t Ubt. ----------- .� -------------- --- APPLICATION FOR SANITATION PERMIT Permit No. ------ _.,�,.t..-^_y�.�J l------------ (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued - Date Issued ._. I. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th wo This application is made in compliance with County Ordinance No. 549. a rk herein described. JOB ADDRESS A OCATIO / Q ---- �" ---------- -----------------------`r:- ------------- --------• -------------.-•-•---------•----• ---.-Owner s Name------ Address -------------- ------ --------------------------------------------- Phone.---------......._..--• ........ Contractor's Name------------ ---------------------------------•-. ----•--•--•-----•- - ----------------- -----------------------------------------------------•----•--••---- Phone_._.... Apartment House ❑ Commercial ❑ Trailer Court h..._"... Installation will serve: Residence ......:........... ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _/--. Lot size Water Supply: Public system ,.,,.,� ��-�-'..�-----�------------------------------••---=•- Y ❑ Community system xd' rrivate ❑ Depth to Water Table &,.jfe Character of soil to a depth of 3 feet*Sand"❑' Grave[[].. Sandy ❑ El Clay Loam Clay Previous Application Made: (if yes,date--------_. - El Adobe Iiardpen C]1 No ❑ New Construction: Yes ❑ No'El j 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."_rn Distance r m foundation..I�P. Material. _ " No, of compartments"." -------•---- Size ., " ` ...... `..Liquid depth"" - Disposal Field: Distance from nearest well- n.,.�_"--_Distance from foundation. - -""------Ca act ,��.�.-_-Distance to nearest lot line.+.`- l�� Number of lines------- ` ______Length of each line- j 9 e. �Nidth of trench.----9---1 Type of filter material.. .- Depth of filter material_"��-"• _Total length__.LoY�..�• ,. .. �•...b. --•-...----•. eepage Pit: Distance to nearest well""_- ------------ Distance fr fou dation----_ `Q------ U5 t ce to nearest lot line".o�1.-_ Number of pits.. --" -----Lining material_. ��y Size:•Diameter` Depth_-,% 'f".1. Cesspool: Distance from nearest well------ ¢ ' DitaNe from foundation--------------------Lining material------------------------------------- ---------------------- ❑ Size: Diameter1----.-----Depth-----------•-- V ---------------------Liquid Capacity------•----••--•---- gals. Q rivy: Distance from nearest well"_.""-"�"-___.__ _�r"_"_____ __"___""""-Distance from nearest buildingEl to nearest lot line -"" emodeling and/or repairing (describe):.:--------- -----------•----------------------------------- ---- ----------•----------------------- -•--------• --•-------•--•-----•-------------- --•-----•-"----_-"------------------------=---•--------"-------•------•-------------•--------•-------•-----•----•-----•--------•----------•-----•--•-------••-------------------------•--------•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r"es and requiations of the San Joaquin Local Health District. By:..............................-..............=-------- --- or Contractor) ---------•---••---•---- - -------------------- .................... (Plot plan, showing sire of lot, location of system in r ton to webs, buildings, etc., can'bg placed-on reve�r ), r R DEP MENT SE ONLY APPLICATION ACCEPTED B VIEWED BY-------•-•------- - - - ----------------------------------- DATE".".""....-" ---- BUILDING ---------- - "'"'�" DATE------ --- __ BUILDING PERMIT 15511ED___"...___.__-"_""____ _ - -"---""""""""""----- Alterations and/or recommendations:".- ------- ATE---•----•----_-•_------ _ - -" ----- D ---- ----- --• - --- ---` ��::::� ::: ' _. .�,_ -----------------------------------------••--------------•------ �. ------------------ - ------------ ------•.----------------•-------- --- F1NAL INSPECTION B �l e ---- % I ------------------- S' JOAQUI OCAL HE TH DISTRICT 130 South American Straat } - 300 Well Oak Street 124 Sycamore Strut ;. Stockton,California Codi,CallFornla 205 Wast 9th Street e Manteca,"WCallfornia� Tracy,California EB 9 " ren B"89 2M 8.61 ATLAS }