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ruRvrrlC.[ Ur-: ------------ ------ ---_.- ----2,1_.d111)-___. APPLICATION FbR SANITATION PERMIT Permit No. ------------------------------------ ------------------- (Complete in Duplicate) Date issued This Permit Expires 1 Year From Date Issued ----- ---------- - -- l fir?� Z2d�3 Z Application is hereby made io the San Joaquin Local Health District for a permit to construct and install th work herein described. This application is made in compliance with County Ordina ce No. 549. JOB ADDRESS AND LOCATIO - __-_- _ ____ Owner's Name 'Pi l (_ -!-- ------- Phone-----------••--------------•--- Address /` > _{ / --------------------------•----------•---•---------------------------•------------------------ Contractor's Name__.___--_ tom ,-._ --- -----: Installation will serve: Residence RT 'Apartment House ❑ Commercial ❑-Trailer Court ❑ Motel ❑ Other ❑ Number of living units- --/._ Number of bedrooms ___- Number of baths � A,5V size -------------------- Y Water Supply: Public system ommunity system � Private ❑ DepthtoWater Table 4>ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam U4-15ay [] Adobe ❑ Hardpan L] r Previous Application Made: (If yes,date------------------__) No R�'New Construction: Yes Ej--No ❑ FHA/VA: Yes R;--No E" TYPE OF INSTALLATION AND SPECIFICATIONS: UY (No septic tank or cesspool permitted if public sewer is available within 200 feet.} �� N� i 1 Septic Tank: Distance from nearest well-----------------Distance fr m foundation_.. / __.._.Mat al No. of compartments_.___._ - ---._...Size__:�� - ----- -- ,.1�`.�Liqu�d depth_-.-�-�-��--------- --Capacity_f,Z��--- 1 - Disposal�ield: Distance from nearest welL..'�-�------Distance from foundation___ __ ___.Distance to nearest lot 99-11 `` Number of lines----- ---------------_ Length of each line-._ .__ ___ ----- 9 �-------p----�� ---.Width of trencfl�--------y-- ------------ Type of filter material�� Depth of filter material_,+ _ --__Tota€ length._ ---------- Seepage _-- __Seepage Pit: Distance to nearest well_-__-..--------- -____Distance frw foundation___ __ -.Distance e to nearest lot Number of pits_-.._v�-__--- _.Lining material_ V�. ize: Diameter.. - --- ----Depth_��✓��,� Cesspool: Distance from nearest well-----------------Distance from foundation---------------- ...Lining material__.__-------------------- -- El Size: Diameter----- --------------- ----------------Depth--------------------- --------- - -- --------------Liquid Capacity- --------------------- gals. Privy: Distance from nearest well____ ------------------ ___________---_._ -_.-Distance from nearest building_-__.__-------------------- --- El ------------ Distance to nearest lot line-- -------------------------------- ------------------------------------ --------------------------------------------------------------------- Remodeling and/or repairing (describe) f h- --` f ` ----------- --------------- 1------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (5i ned 9 ) / Gl !_ '-- ------ -- ---- - ---------------------- I�`�r Contractor) Y ---------- ----- Title B .------ ------. ,_ n r' (Title) /'1 (Plot plain, showing size of lot, location of syst to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------------------ ------ --------------------- -1 - -------------- DATE------ � � --------------- REVIEWEDBY------ ------------------------ - ------------------------------------------ ---- ---------------------------------------- DATE--------------- BUILDING PERMIT ISSUED------------------------- ----------------------- --------------_ DATE Alterations and/or recommendations:._____._ - _______.. __ - _ - --------------------------------------------- ------------------------------------------- ?-------------------- ------------------------- -•---------------- ------------------------ ------------------------ ----------------- FINAL INSPECTIONBY:------ _--------------- - Date--------- Ya SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.a.co.