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rUKUN-KA: USE: --------------------------------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. __4 .'.Z ------------- -to ---- ------------------ (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 ADDRESS AND CATION__.__ ------ ---------7Z_- -----Re a,,Ch . .: 1�� Owner's Name____ _ Phone_//,(,&_--zg/7'�0----- Address----------_ _ Contractor's Name___ .......-- --------------------------- -------- ` -------------------- Phone - - - --- ------------------------------ Installation will serve: Residence [0] artment House ❑ Commercial ❑ Trailer Court ❑ Motel pA,s/� ❑ Other �1G��C - f Number of living units: -------- Number of bedrooms ___-___ Number of baths _____ Lot size __"- - _ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table ---.____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Cla Loam Cla � Y ❑ Y ❑ y ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date---.----------------) No ❑ New Construction: Yes [� No ❑ FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pt c Tank: Distance from nearest well-_/6-0.._.-_-Distance from foundation____Ifl./______ G _MateriaL_____ fl!(j(:2t_ -- - ------------ No. o compartments ----Size------41K_`.Q-------- --Liquid depth--------� .. ------. Capacity-------/'10_0- Disposal Field: Distance from nearest well----(i_C;� Distance from foundation---L_a ___-__-Distance to nearest lot line_______.__ Number of lines __-Length of each line---LC�_X.LG_S ---------Width of french-____LC?� Type of filter m terial._AevC,AC---------Depth of filter material----1_�L............Total length-----/Q_�2__�__-_---__-__----- ________. Seepage Pit: Distance to nearest well ___- __.-_____Distance from foundation _________ Distance to nearest lot line-______-_______.- ❑ Number of Pits----------------------Lining material_-------_------------Size: Diameter__________ } --- ----Depth----- ------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity------------------------ gals. LA F1 Distance to nearest lot line Privy: Distance from nearest well___ ___-_-__ Distance from nearest building ------- ------------------------ A ____ __________________________________ - ---- --------- -- - --------- --------- - -------- --------- Remodelin and/or re airi escribe :__-___. 210- 9 / P 9 ) - ------------------------------------- _ - G'- - P ----------- �a 1 G ----- - `'- - 1 U ----------------------------------------- -------------------------- _ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) { j --- --------'Y ------ ----------- ----I---'------------------ ----------------------------------.(Owner and/or Contractor) BY� -------- Tale - ----------- ---- ------------------ --------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ fr.,---- - - ---- ------------------------------------------------------ DATE---_�r_r3:��---------- - REVIEWED BY------------------------------------------- ----------------- ------------------------------- UILDING PERMIT ISSUED-------------------------------------------------------------- ------------------------------------------- ---------------------------------------------- DATE-- - ... ----------- Alterations and/or recommendations:_____________-.____-_--_- --------- - - --------------- -- ------------------- - ---- ------- ------- ----- ------------------------------------------------------ Dat -------- FINAL INSPECTION BY:.- r-- ------ - ------- -- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California s Tracy,California F.a.00.