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l ---------- ------ ��-____ ------j -_-_____________._ APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -- - - (Complete in Du 2 -�------------ ( P plicate) - - --- ---- --- - - -- This Permit Expires 1 Year From Date Issued Date Issued _-_y/C-./6__� 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 Ordinance NQ_ 549. JOB ADDRESS AND OCATION___ ----1;?Z) Phone-- � Owner's Name------------- -- .. Address_ '�- � � j - -- ----------- --- --r------------ ---�----- -- -� Contractor's Name------tsidence t G-----------�---- ❑ ------ Phone..--.e - - -- --------- Installation will serve: Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .x- Number of bedrooms _J--- Number of baths =---- Lot size -_-.-BQ__. � Water Supply: Public system X Community system ❑ PTivateWDepth to Water Table,:` ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--- -----.----------) No ❑ New Construction: Yes ❑ No D FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,. Septic> Ak: Distance from nearest well_ _e4_Distance from foundation_YQ- Material No. of compartments----- ;— --------_---Size- Liquid depth-----�-------------Capacity,/__J�_�_Q_� isposal Field: Distance from nearest well--------------___Distance from foundation-------------.--.. Distance to nearest lot line.-_-_._-___-.--.. Number of lines------------------------- Length of each line----------------------- _.------.Width of trenchvzt� ----------_---_---------- Type of filter material---------------------_---Depth of filter Material.____________--------Total length------------------------------------------ __ _ _ -------------------- Distance to nearest well----------------- from foundationDistance to nearest lot line Seepage Pit: W ❑ Number of pits----------------------Lining material-_______________-SiDiameter ameter.___------------------ - Depth----------- 4 ' Cesspool: Distance from nearest well.___.._____-__-_Distance from foundation_--------- ---------Lining material..____ --------------------- ____________________-..--_ (" 171 Size: Diameter------------------------------------Depth----------------- --------- - ----- - ------------- Liquid Capacity----------------------------------------- -----------.gals. Privy: Distance from nearest well_____________________--_--____ _ Distance from nearest building ` tel El Distance to nearest lot line______ -------- q -------- --------- _ Remodeling and/or repairing (describe):____ . - ---- - _ s%�- ----------------------------- ----------------------------- ` - ---------------------- - ----------------------------------------- ------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Soke laws, and rules anregu tions of the San Joa juin Local Health District. P (Signed)----- 141- �. BY:--------------------------------------- ------------------ -- - - - 1 - ----------- _ _(O _(O and/or Contractor) ner -------(Title) (Plot plan, showing size of lot, location of system in relation to ells, build ngs, etc., can be pl ced on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._____ -f ------------- DATE---REVIEWED BY ----------------------------- --- - ------------ ------ DATE---------------- ----------------------------------------- BUILDING PERMIT ISSUED- --------- ------- -_-_�_-_-_-_-_-_-- ---- ------ Alterations and/or recommendations:_______.__-_ ------ DATE.- ---------------------------------------------- -------- ------------ --- ------- - ----------------------------- ------ --- ------------- - ------------------------------- FINAL ------------------------FINAL INSPECTION BY:.--_--.- .%� ------------ Date. - =�� ' - f S JUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street F.P.CC. Manteca,California Tracy,California