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FOR FF CE USE: 3Q ------- -- aqfi_ „ -- �_.... APPLICATION FOR SANITATION PERMIT Permit No. . --------- --------------------------- - -----=------ (Complete in Duplicate) -- Date Issued __.7.- ----�--•�-� ------------------------ --- ----------- - - This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Localf Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance Uo. 549. �rrQ ` ---••-----•---------------------------- JOB ADDRESS AND CATION------ 2�Q _� ------ ---- ---- � I ` - --- Phone---- ------------- ------------- jE7POwner's Name I - 5 --Address-----------•-------- \---r----- -� J'�>----- '--_-- --------- - --- Name-- 11 Lj ---------------------------------- Phone_ _: Installation will serve: Residence [ :Krtment House ❑ Commercial ❑ Trailer Court [I Motel L_] Other ❑ Number of living units: __�____ Number of bedrooms _--_ _-_ Number of at _�__-_ Lot size ._ _�-----�•-�-• --------- stem Community s stem ]Private Depth to Water Table -------- ft. Water Supply: Public system ❑ Y Y Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: :(If yes,date-----------,--------) No ❑ New Construction: Yes ❑ No7%q"- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: jNo septic +ank:or cesspool permitted if public sewer is available within 200 feet.) , a Dn lstact from neares�+we1____- n �---- Distance from foundation-------------------- a No. of compartments------ -"'�"' �-.Size Liquid depth------ - -- Capacity----------•---------- -___-Distance to nearest lot line___ -__ D• a6-5 : Distance from nearest wel __ -_Distance from foundation____ ___._ l ------- Number;of lines_ '� Length of each line_ ! -----------Width of trench_%Z -__�7_'G�------ --- ------ Type of filter mafi�rial -r *61_ - Depth of filter material__f ____-_--Total length_____________ Q- �Y t S , 3 5eepa a Pit: Distance to nearest well-_-f! Disfance om f undation--- p_=_,._.D' to e to nearest lot line__ 4!}_o ,Number of pits----_-_-_-___--- Lining material____._. .-.__.Size: Diameter___ : —00 Cesspool f �'� Distance from nearest well______-________Distance fro oundation---- -------------Lining material-_._---_-_--__--___-__-______�__- ❑ / -. Size: Diameter------ ---- --------� R--------Depth----------------------------- -jj-``/--------- ------Liquid Capacity----------------------------gals..„ Distan�Ce from nearest building Pri�vy, Distance from nearefiAf well__.- gi LJ " z , Distance to nearest lot line-------- --- ----------- -- -- � = 1 ------- ------------------------------ .. �,� ao Remodeling!nore.pa 'i4�g (describe--------- ----- �y # d 0// ----- I?7C - ' -4 1 . :: ---------------- ---------------------- -- ----- ------ ------ - > 1 I hereby certify that I have prepared this application and tha+`+he workwill be done ilt accordance with San Joaquin County •. ordinances, St t I and''rues and regulations of the San Joaq in Local F Ith Dis+rictF, ' �°� , ---- ------- - ----- er r °ntractork I -- ----- -- rf/ (Signed -- --------- - - -- - ------- ° i - y a • • --- ------ - - .�.[�w��rrr�TT+I81--------------------------------------------------...--------- By•-------------- - •---- --- ------ ----- (Plot plan, showing size lot, location of system in re ion to wells, buildings a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --- _-_ DATE__ —0 _7 [�------------------- ---- ------ - FREVIEWED BY----------- ------ DATE----------------------------------------------------- BUILDING PERMIT ISSUED-----•------------------ ---------- DATE---------------------------------------------- --------y- ----- / Aterations and/or recommendations:---- • — - �; ---------- -------------------------------------- --------------------------------- - ---------------------------------- --------------------- - - - --------------- -------- •--------•----- ------------------------ ------------------ --- -------- -------j -- -------- ------•--------------------------------------- - - ----- �j ��-G ---------- - FINAL INSPECTION BY:.---- -------------------- - ----- Date -- - ------------------------ e!!7>; N SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasallan Ave. 300 Wesl Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California. Lodi,California Manteca,California Tracy,California F.P.CC. - i