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rUKVI-FICE USE: L__---s_----'._.S,q� ._..___II'_. APPLICATION FOR SANITATION PERMIT Permit No: .. _ � ``r'f.4p ------ +(F�omplefe in Duplicate} -------- This Permit Expires 1 Year From Date Issued Date Issued 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 compliance with C unty r-inance No. 549. /DFU .� p�if _ r JOB ADDRESS AND LOC 'TI N_.. r------ - ---- Owner's Name--------- ----------------------- Z p Pho:ie------- Contractor's Contractor's Name--_---_. ----------------------------------------------------------4------------------- --------- Phone------- --•- -----• -------- Installation will serve: Residpce ❑ Apartment House ❑ Commercial ❑ Trailer Cour '❑ Motel ❑ 1U i Number of living unitsc "�--- Number of bedrooms ._ -.- Number of baths -S._ Lot size � �- ----- -•-- ----------•-------------- l Wafer Supply: Public system ❑ Community system ❑ Private grobepth to Water Table vWff. Character of soil to a depth'. f 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam [] Cfay;'❑ Adobe ff"'i""Hoardpan ❑ Previous Application Made: Tfyes,date--------------- ] No New Construction:"Yes 2KNo ❑ FHA/VA: Yes ❑ No G-- TYPE OF INSTALLATION A&D SPECIFICATIONS: I ii J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance ' rom nearest well_ _ Distancerom f ndation___h._.!_ M aL .l - '� -- _____-_ e ry�� No. of compartments. .___ _-.__Size _ _--_--- ---n, Liquid clepth_` /� Ca acit' Qom_ ` �[� Dis osal d: Distance from nearest well,�� ---.Distance from ation-A0 p Number of lines Length Length of eacFi lif�p� _- VDVidthcofttrenchelt line_ E Type of iter material/ -Depth of filter material-. - A Total length .-��--------- O Seepage It: Distance to nearers�weli_.�Qf-------Distancefro fou dation_-i:ZO_-:Distance to nearest lot line--. ------ f- Number of pits._-- ------_--___Lining maferial___X -Size: Diameter.____�T-__ _---Depth__1/f9-_-,f.2_` Cesspool: Distance 1I� lfrom nearest well-----------------Distance from foundation!-------------------Lining material--_._----_--------___ - r ❑ Size: Diailf eter------------------------- -----------Depth---------------- -------------- ------------------Liquid Capacity---------------------- -----gals. Privy: Distance.f rom nearest well_________________________..__ __Distance from nearest,buildin ------ g-- --------------------------------------- ❑ Distance��to nearest lot line-------------- Remodeling and/or repairing: (describe):---------�'�y + ---- �g7: � 5 r ---------- -•-------- 41 I� = 4- --'-----•-------------------- ------•------------------------------------------------------------------- --------`=-------------------------------- ----- 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�lles and regulations of the San Joaquin Local Health District. F (Signed)------------------- ------------- -- -------------------------- By----------------- �I. (Title}._. or (Plot plan, showing size of lotillocation of system in'r ton to wells, buildings, etc., can bte placed on reverse side}. ' �I I 1 � , �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ --------------------•-----------------------^DATE----- __`. a' ^- REVIEWED BY--- --------- /-------�- - - ------ ------ _ • --- -- ----------------------- ----- DATE----, ---�---------- ---------------- -- --------- BUILDING PERMIT ISSUED--- ------------____ _ ,DATE--- --------- ' ' Alter ions and/recommendations:_____ . /..__®� �'-_ -_65,_--------------- y. - .�;3 ._.. f --- ----------- -- ---------------------------- --U 1S7er jQc. `� � -- r --- ------------- -- ----------- --------------------- ._ l ---- -------- -- --------- - Illi !/ FINAL-.INSPECTION BY:__ _ -------------- Date- _._ ------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT V i 1601 E.Haxellon Ave. 300 West Oak Street 124'Sycamore Street 205 West 9th Street , Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ct7. i