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FOR OFFICE USE: = = ---------------------/ � ' l l ,C�-.-- APPLICATION FOR SANITATION PERMIT Permit No. .................. --------------- ------------//-E---------- (Complete in Duplicate) This Permit Expires 1 Year from Date Issued Date Issued ...-- ------�•-_--_-- Application is hereby made to the San Joaquin1ocaI Health District for a permit to constr ct and ' stall the war herein scribed. This application is made in compliance with County Ordinance No. 549. �.5l ` 0,el- ��e /Z.9 _ J � _ U JOB ADDRESS D LOCATION.- -- ------�-------- -.,4----- --- - _ Owner's Name---- -----� -- fry¢ �G `t`ir� ------- ------ hone`" V-4 Address -------------- -------------•------------------------------•----------------------------------------•- y -- Contractor's Name--- --••------- --- -- 1�--- �~---------------- Phone. Installation will serve: Residence ppartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..... Number of bedrooms J- Number of baths ... Lot size ---- `_ ~...". Water Supply: Public system ❑ , Community system ❑ Private epth to Water Table .67 Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (1f yes,date---------------____) No New Constructi. n:.Yest-] No ❑ FHA/VA: Yes ®/fro ❑ TYPE Of INSTALLATION AND SPECIFICATIONS: �� t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic TAak, Distance from nearest well... ---Distance from foundation...,1.41------Mater jal___q�- ------------------------------- No. of compartments------3-__-�----.Size- 'j..� l-Liquid depth-.- - l Disposal F' 4d-- Distance from nearest well.-s�__-...-...Distance from foundtian.. .----JDistance to nearest lot [ Number of lines-.----- - ..---Width of trench.-..r�-- ---------- -------- ,� - Length of each line..-.- _- - , Type of filter material__- -_ ` ' De th of filter material... Total len th___._ �� P a g — ----------------------- Seepage Distance to nearest well-14!:Yl.... Distance founclation_._ 0-_j---- Distance to nearest lot lin .. ---1 Number of pits-cZ-.----------Lining material-__ _-_..............size: Diameter.-��...�.-..Depth. -... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining ----- � ------ material- ..--..-----------..._.._..-..-._-. ❑ Size: Diameter_ ------------- p �------------ �- Li uid Capacity- - ------------------------9a s. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- -- ❑ Distance to nearest lot line------------------ ------------ ------------------------------- ---------------------------------- ----------------------- 1 Remodeling and/or repairing (describe=- - ----- -----z �-------- - ' - ----- -��------------- - - ------------------- --------------------------------------- ----------------- N ----------------------------------•---------•------•---•----••-•------------------------------------------------------------------ ----- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ - I ----------------------------------- ---------------------------------------------------------------------------------------------;------------------------------------------------------- --------- 1 hereby certify thafll have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, ao rules and r ul ions of the San Joaquin Local Health District. ' -- - -------- -- ------------ ------- -- ------------------------------- ---------- - Owner)an or Contract(Signed)---------- -r - - _ _ _ - ----{ / { By:---------- --------------- ---- --- --- ---- ----------- ----- {Title) ll� showin size of o location of system in relation to'v�[Is buildings, etc., can be laced on reverse side). (Plo+ plan, g y � 9 p 'JO FOR DEPARTMENT USE ONLY FREVIAPPLICATION ACCEPTED BY = `r = - '; ----------- DATE--- - �--------------------------------- REVIEWED EWED BY------------------------------ ---------------------------------- --------------------------------------------- DATE--------a--------------------------------------------------- 0 BUILDINGPERMIT ISSUED------------------------------------------------------------------------ ----------------------------- DATE------ -------------- ----- --------------------------------- 'I1 Alterafns and/or recommendations: - ---- ------- ------------------------------------------------------------•-••----•---------------•--------------------------------------- ` --�— �G .� J' !.......-<--------•------------- FINAL [NSPECTION BY:---------- A ----------------------- - -- ---------- Date.----- ----T � �%- ----------------------------------------- 10 t I - - - • 1P SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltort Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manleca,California Tracy,California F.P.CO.