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t-UK UrrIC.L USE: F�•-- — _-= APPLICATION FOR SANITATION PERMIT Permit No. `:(Complete in Duplicate} Thg Per m t Health District From Date Issued Date Issued.__�-- - , Application is herebymade to the San Joaquin Local for a permit to constr This application is made in compliance with Cou ty Ordinance No. 549. uct and insiail the work herein described. Sk7AO .,i1 f3�,�GSE e' 5 T- f1 67 JOB ADDRESS AND LOCATION_. -- _– _- Q �E f4 d /. ' ------ Owner's Name--- --------- ---�--------L�.f. -- - � - Phone 4 Z -----•- - � Address------------------ - -------------- Contractor's Name----------------------D---!Y--R---...... -w�lA--I�p.�.5�t Installation will serve: Residence Apartment House El Commercial ❑ Trailer G ur 0 Motel ❑ Other ❑ `._ } Number of living units: _-� .."Nu'mb " er of bedrooms -Number of baths / --_ Lot size Water Supply: Public system [] Commuri,ity system��❑ 19f p %.:?_zft I Private De-t�h to Waf<T ; Character of soil to a depth of 3 feet: Sand Gravel ❑ -Sandy Loam E] Clay Clay� J y ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date.----_ l No ti `New onstr'uciion�: 'es 1 ` } ; ' } " ❑i No FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is ava�`lable withi�' 200!ieefj, f.r Septic Tank: Distance from nearest well___--_-::.- Dis#ante rom found Afi " 1 p f �r �/, afion- Material------- x •-- ❑e L1 S'ko� No. of compartments-_--A _ A '� � ��'.s�• ! ,`. � _ - -- Size Liquid depth 1 ___- - ---- Capacity------ ----------- Disposal ' Field: Disfance from nearest well ll_ ---�__Distance 'rom foundation__ - /_0..--1-.--.Distance to nearest lot line. 1 k ` Number of lines_-_ _____ # �i ., Length o each line-%Q0__--_.-- Width of trench- -_-- ~e, Type of filter materiae iT � _ _ p filter ma+efiia'I�.-�-�-- -! ---Total length_�--1�� r--------- Distance --_ B Seepage Pit: Distance to nearest well- -. e t o � '�1 Distance rom foundation_�..___~�-_---Distance.to niarest lot line--------rEl Number Number of pits Lining material i`----V�Si ze:-Diamete--- t Depth l Cesspool: Distance from nearest well.__.-------------Distance rom foundation------------- -__.Lining material---_-_-______.-_-_.- P } ---- ----- ,. ❑ 5¢e: Diameter- - ------- --- ---Depth------ ---------- -- r` y ------------ ----Liquid Capacity ------- ---9als. Privy: Distance from nearest well------------------ --------_--__ .-- ------- _-Distance fromearest buildin ___________________ 1 ! ❑ Distance to nearest lot line---------- --- f g' --.-_- s r ------------ ----------------------------------------------------------------------------- --------- RemodelingRemodeling and/or repairing (describe):---_-- Ae- -, - - -- ----_-- - ------ -_-----------•----------------------------------------------- ---------------------_---------_------------ _-_- __---_--- ----- ------------------------------------------- -------.---------- --- -------- -----------------------------------------------------------------------------------••------------- --------------------------------------------------- ----- j------ I hereby certify that I have prepared this application and that the work will.-he done in accordance with San Joaquin County, ordinances, State law n rues a regulations of the San Joaquin Local Healf'h District. (Signed)------------------------------- T-- . ----- 5-. (Owner and/or ConM30o BY: - _ R /� ,�"----- �`-'��.-----��f-=-�--- ----------- ----------- ---------------{Title}------ }$i Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---._--_. ----------- - ---- -�-�1 f ------------------------ ---------- DATE------Z. 1.3 .G--G----- ------- BUILDING PERMIT REVIEWED - ------------------- ------ --- -- ------------ ---------- ---- DATE--------------- ------ ISSUED----------- - ----- ----------------------------- ---•-- - ----------- ----------- -- DATE-- --- ------ -- ------------------- ---------. �-•--�. Alterations and/or recommendations: ------------------- ------------------------ --------------- I ---- -------------------------------------------- ------------ -- -------------------- ------ ------------ --------------- ---------- FINAL INSPECTION BY:._-_ --- I Date SAN JOAQUIN LOCAL HEALTH DISTRICT u 1601 E.Noxelton Ave. 300 West Oak Street 124 sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California I