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��/��--v -------- - -- - U ---------------- - -------------- -- APPLICATION FOR SANITATION PERMIT Permit No. --_-.�_ / -- --------- ---------------- (Complete in Duplicate) 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 Ordinance No. 549. JOB ADDRESSND LOCATION____." r52Q.0�__ ', // Owner's Name_ _0-f'tO/j1 jM ---------------------------------------- -- ---- --------- - - ----------------------- ----- Phone Address----------------s-� _ ---- -------l-�- r t �- -�?j----j---------------------------------------- Contractor's Name_.. '� � - ------•------- -- Installa+ion will serve: Residence ,� -""------- ------------ ------ Phone.fit_ L�Apartment House ❑ Commercial ❑ Trailer Court Number of living units: __l__._ Number of bedrooms ..�" Number of baths ._ ❑ Motel ❑ Other ❑ f " / P Water Supply: Publics stem Lot size .._ ,v__-- __l �Q� Y Community system [] Private ❑ Depth to Water Table -eft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-lHardpan ❑ Previous Application Made: (If yes,date- ------- -------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if wwp��ublic sewer is available within 200 feet.) Septic Ta Distance from nearest well-A&r Z)Distance from fougdation_. _ No. of compartments_ �D "Material "_Irl. jf -- ---- ------ ------------------ -- --- -- - --- --_Size"lf---X-�.�=�- .�_1Liquid depth_._ �( ---- -- Capacity-g'". _ DisposaEZL-1 Fi d: Distance from nearest well_t4try�Distance from foundation-_ I� I Number of lines__. _ --�----------Distance to nearest lot line-_----a Length of each line.__�'{f-I"-----__-_Width of trench. _ Type of filter ma teri •' '� �� ___Depth of filter material_.__4" - off " " ----`-- Seepage P" . Distance to nearest well-ZZ Total length-------- _--� .__Distance from foundation C1_�4_.Dista ice to nearest lot line__._. 'or— Cesspool: of pits______ .__-_- __Lining material_. p ee�JJ Size: Diameter_ _--__-Depth_Distance from nearest well _.__Distance from foundation----------------- - Lining material----- El Size: Diameter_ _. -------------- --------------Depth--------------- -- - -- - - ------------ - ---------------- ` Priv -- - - - - -----Liqu'd Capacity-------------- �i Y: Distance from nearest well___-------------- _---_------- ----gals. __ -_Distance from nearest building -__- ___.--- " ❑ Distance to nearest lot line---- --------------------------- -------- ------------------------ VN--------------- emodeling and/or repairing (describe):_---__--- ----------------------------------- --•-•-------------------------------------- -- ---------- ---------------------------------- -- -------------- --------------------------- ------------------------------------------------ ---------------------------------------------------- ._---_-- _"_.__-___- 1 ------------------------------ "--------------------"-"..._._"-._._.---------------------------------------------------- ---------- -----.-_-.___----_---_.--- --..-.._._.__- ----_- I hereby certify that I ve repared this application and that the work will a do a in accordance ith San Joaquin Count ordinances, Std nd and r ations of the S Joaquin al Hea h D' ric+. Xci q y (Signed)---- k.. Q ` -------- -- --- ---- ----- - nt or) (Plot plan, showing size of lot, location of system in rela ' o wells, buildings, c., can be placed on reverse side). ------- it e)----------------- ------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ REVIEWED BY------- -------- -- - ---- ----------------------- ------ DATE-- ----------------------------------- ATE- /I 1 .................................. BUILDING PERMIT ISSUED_."._..___""_ ----------------------`-----_ " ATE --------------- -------- ------------------- ------------------terations and/or recommendations: DATE --------------------- FINAL INSPECTION BY:"---Q- ore-1,2------ ----.. ._ ---------- ----- ----- - Date-- .1-1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California 205 West 9th Street Manteca,California F.P.CO. f _ rs. r Tracy,California