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VRV' I Il-L VUL-------------------- --------------- --------------- --: ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .-/-- -.-.•- ------------------- - (Complete in Duplicate) s ------------- 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 County Ordinances No.f549. _ f JOB ADDRESS f/(/�-� RE55 ANb LOCATION_____________________ ------------------------ Owner's - Owners Name--.. � t . -- 7�+ 4 - ----- ---- ------- y w Phone-------------------------..--------- Address Contractor c r F ` � .. --••----•--- 's Name-------- - - -------. `- •------------ -.---------•--.._. Phone------------------•-••-•---•------- Installation;will serve: Residence UT Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: ___1___ Number of bedrooms 3-- Number of baths ---/--- Lot size _________________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table S-0 ft. A Character sof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[r-�Hardpan ❑ Previous Application Made: (If yes,date--.---.------- No New Construction: Yess'R No ❑ FHA/VA: Yes [jNo �r I TYPE OF INSTALLATION AND SPECIFICATIONS: w — (No' septic tank or cesspool permitted if public sewer is available within 200 feet.) - -� NoI � � r _ Se tic T 'k: Distance from nearest we'll__,`--q------Distance from foundation_di0______________.Material____/"_-_---------------- -------..._____- P No. of cam artments__ _____________. ~x-__ _ / Od P -----Size---- Liquad depth------X--- Capacity-----Y-- --- _ Disposal Fi _ p eld: Distance from nearest we _____._Distance from foundation___f0___,.-__.,_,Distance to nearest lot line__�l__..- Z , r Number of lines__,_____________ _____________Length of ea�hllne_1 ----------'_----�� Width of trench _��t__�___________-._ jType of filter material_ CrG.�(__-_____Depth of filter material__!r_y_________.Total length-__.+�:�U__r_____________________ I ------- Seepage ,it: Distance to nearest well------_--------_------Distance from foundation_______.._.__.____.Distance to nearest lot line_____.___________ � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter—---------------..___.Depth--------------.-------------------seas 0- Cesspool Cess oolc Distance from nearest well--------------___Distance from foundation--------------------Lining material____._._..._____._..____.____________ P Size: Diameter---------------------- -----------De th---------------------------------------------------Liquid Capacity - gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest,building_____--_______.__________________.._.--._. ❑ j Distance to nearest lot line--------------------------------------------------------------------- ------------•--------------------------------------------------------- Remodeling and/or repairing (describe): -----------------I----------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ------ ----------------------------------------•----------------------------------------------- ------------ ----------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application ajid that the work will be done in accordance with San Joaquin County ordinances', State laws, and rules and regulations the S n Joaquin Local Health District. d P � --------------------------------------- -------- - ------------- ---- -----(Owner and/or Contractor) r l (Signed) Plot lay'�---------•-----------------------=-------- ----------- -- ---- ---- ------------ - ----------------------------------------(Title)---------:�--------------------------..__ -- Y• ( p ,[showing size of lot, locatl to relation to ells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________ -•----------•---- -------------- DATE----------REVIEWED BY-------------------------------------------------- ---- ----�--�-------------------------------- DATE---------- - BUILDING,PERMIT ISSUED--------------------------------------------------------------------------------- ------------------ DATE--------------------' Alterations and/or recommendations------- -------- --- ------11----------- ------•--------------------------------------------------------- ---- - --••---•-•---------------------•--••--•---•-------------......_..---....--------••- ---------------------------------------------------------------------- --------- .... � - ----------------------------------------------------------------------- ------------------------------------------- - -`e FfNAL Ii � � � NSPECTION BY:----- -- --- r1 �:�__�'...F'�y'`' Date-.---------- -`` ------------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street iStockton,California Lodi,California Manteca,California Tracy,California L ES 9 REV15ED B-59 3M 3•'63 F.F.CC.