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--�� Y J'lry --------------------- �� - APPLICATION FOR SANITATION PERMIT Permit No. .�� (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued14, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install work 1described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OC TION- Owner's Name.___ �- / ----------- Phone - Address_.----------•----------- ---�-�� ------•--- - --•- --------------•"-- Contractor's Name_.-. "" - -- ••••----•- ------------------------------------------------ - -------- Phone Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court j ❑ Motel ❑ Other ElNumber of living units: __!_. Number of bedrooms_ __umber of baths -f--- Lot size Water Supply: Publics stem i PpY� y ❑ -------- 'Community system ❑ Private �l�pth to Water Table _6,S`ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Y ❑ Adobe dpan ❑ �i Previous Application Made: (If yes,date.,---....__-- I No p -- New Construcfiion: Yes ��o FHA/VA: Yes ❑ , No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet:] Distance from nearestwell__--"_ Distance from foundation_____.Se tic T No. of compartments.- --- ---------- --Size--- - f�vLiqurd depth Disposal - ........Capacity----- - -- ---- Id- r,. Distance well-. _� Distance from foundation----/Q-.�---- Distance to nearest lot line___..-, Number of lines- "--- Length of each line____-16-T F-40'?--..Width of trench_. � `. Type of filter maferial-.. _f �j - ---------------- �$ Depth of filter material--- Total length_.".-,/C-e -! """ ------------- See pag it: Distance to Weare t well.___"�"_'�__�-.__ "j}istance om f ndation____t;-_�___. e r__" Distance to nearest lot line___ NumlSer of pits....-------.-Lining material--- t f" " Size: Diameter__. � ` Cesspool: ---- �__�--�---- --Depth--�1.-•�-.- --- ' p Distance from nearest well -Distance from foundation_______ ______ I Lining material______________________ Size: Diameter-----.-------------------------------- Depth--- - -------- ----------- --------- ��`------ q p Li uid Ca aci# Priv 11 Y ------------gals. ., Y Distance from nearest well-------- ------- --_.-------Distance from nearest buildin Distance to nearest lot line______________________ __ _ ------------ Remodeling and/or repairing (describe):----------- .. /},,A y ------------ " ' ---------------------------------------------- p A ------ --�----- ----- ------------------------------------------------- - ! hereby certify that I have prepared this'a fication and-thaf-thework will-156—done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. (Signed) 1c -------------(Owner nd/or Contractor) BY:---------------------- ----- Y (Title)_ {Plot plan;showing size of 1 }, cationtof s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- - --------------- ----------------- DATE---------- REVIEWED BY---- --------=-- -------- -------- ---- --- - �---- �---------- ----� �'---�---- - - -------------------------- ------ DATE---------------------------------- ----------------------- ------------ UfLDING PERMIT ISSUED-------------------------------------------------------- ---••------- ------ ------------ -- --------- _ ------------- --------- -- ----------- Alterations and/ r recorn enda ions:__---, - 6-�--. ` A E__ -------- --- ----------------- 7" �- ----- - " ------------------------------------ ------------------ E fy"--- - ---------------------------f _�f=l'NAL INSPECTION B ; r� . - '�rr--- bate. {M </------- ----------- ----------------- �{ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haielton;Avo. 300 West Oak Street 124 Sycamore'Sfreet 205 West 9th Street Stockton,Calijornic Lodi,California c, Mameca,California P., Tracy,California 3