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t-(-)Kul-HCF USE: ----- -- - --- __. -+ _ ?____�-• - __ - APPLICATION FOR SANITATION PERMIT Permit No. ..�`Z...�/l`� -------------------- -------------------- -------- (Complete in Duplicate) ' This Permit Expires I Year From Date Issued Date issued l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in deSC7ed. This application is made in compliance with County Ordinance No. 549. j J p ! JOB ADDRESS AND LO ATI N_ f _ Ce d ----I�--. �--- f7 _--- } -- 'L_p =------------------- Owner's Name-------- ----------- Phone__. Address--------• { � `_ Contractors Name. y ^' ----------------------------------------- Phone----------------------------------- .1 Installation will serve: Residence Apartment House ❑ ! Commercial [] Trailer Court ❑4 Motel ❑ Other ❑ Number of living units: ---/_ Number of bedrooms .-/-- Number of baths _ __ Lot size _A?je##'0` d� - .,. --------------------------------- Water Supply: Publics stem /W t pp y� y ❑ Community system ❑ Private ��epth to Water Table�.d"� ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam �'rClay Loam El Clay E] Adobe [❑ Hardpan ❑ • d Previous Application Made: (If yes,date------_-------- ---1 No gr New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well _ _______________Distance from foundation_______ _ .__ Material___..___-__._._____..._.._-___________.-_.___. 41 tAy No. of compartments------- ------------------Siz --------------------------------Liquid depth---------------- _ / e � -- -----Capacity------------- ---�-- Disposal Field' Distance from nearest well_____ _Distance from founddtion__��_..____.Distance to nearest lot line, Number of fines_.___.__"---- -- -- --- Length of each line---¢_t .`-• f -----Width of trench- ---- --------------------- � f Type of filter materiae Depth of filter material -- -- Total lengthfr Seepage Pit: Distance to nearest weii - -_Distance fr m foundation__= _____.D' nce to nearest lot h '-_-_------- Number of pits._._..---_______Lining material_/�� -Size: Diameter.. ___________Depth _ i ' Cesspool: Distance from nearest well_________________Distance from foundation-._._:^__- 1� 0 -----.Lining materiaf--- ---------------- ----------- ❑ Size: Diameter--------------------------------- ---Depth----------------------------------------------------Liquid Capacity-----------------------.....gals. -� i Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building - F1 Distance to nearest lot Gne----------_.„- --------- b .--- ---------- ----------------------------- ee Remodeling and/or repairing (describe)____________________ J -- --------- ---------•--•----------------------------------------------------------------------------------------------- ° -------- -------------------------------=------------- ----------------=---------------•-----------------,------------------------------------------------------------------------------------------------ ---------------- 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 rul s a d regulations of the San Joaquin Local Health District. (Signed) ----------------- -(Owner and/or Contractor) By:-----------------------------------------•---=----tsysf;em trion w . Title (Plot plan, showing size of lot, location oto welts, buildings, etc., can be paced on reverse side). r F611 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.--- - -- ------- /f �''-`` _------------------------------ .� ----__ DATE -----�-- ��-�------•--_��__ ------ - REVIEWEDBY-------------------------------------------- ----------- ----------- ----- DATE------- - ----------------------------------------- UILDING PERMIT ISSUED ----------------------- DATE -- ------ ---- Alterations and/or recommendations:._.__- X irgr _ ___- �--- 1 � --------------- ---------------- ----------------- ---------------------------------------------------------- ------------------- I---------------------- --------------------------------------------------------------------------------------.._..------- l FINAL INSPECTION BY:....... Date---- 1...'l- l ---- ------ -i---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kasenon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cp. C i