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/, --------------- ----------------- ------------ _-___._._____-____--_- APPLICATION FOR SANITATION PERMIT Permit No. ___. __ -------- - -- (Complete in Duplicate) ------ This Permit Expires i 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 LOCATION___-__-_-pZ-_ "� Owner's Name-------------•--•-----•-- ------------------ �+ --------------• --�---- Z__1Z-------------- ------ ---------------------- Phone__7, 1', _Q. Address - ------- ` J / - --------••------------------------•--- - ---- - Contractor's Name---- ---•--------•-� - - ----------•------•----•---- -•-- ------ Phone.x��_Q46,O_;Z- r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Number of livingunits: "- ❑ Motel ❑ Other (] ""- Number of bedrooms _—a Number of baths J---- Lot size -__ Water Supply: Public system -- Y ❑ Community system ❑ Private LeDepfih to Water Table _6® f}, i Character of soil to a depth of 3 feet:.Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay Previous Application Made: (If yes,date------ ---__ E-1 Adobe [ Hardpan ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: I No New Construction: Yes E] No FHA/VA: Yes ❑ No E;J— # (No septic tank or cesspool permitted if public sewer is available within,200 feet.) I Septic Tank: Distance from nearest well--------_--------Distance from foundation---------------- Materia! ❑ ,No. of compartments----- ---- --- ----- -- ------ --------------------------------- -Size-- ----------------- --- -----Liquid depth-------------- ----------Capacity------- ------------ _ Disposal Field:'_ Distance from nearest weli.... __ Distance from foundation__:� Distance to nearest lot line___- J "� Q Number of lines----_-------1---" i Length of each I'rne '"---------_- - Width of french. Type of filter material_-" / [ pep}h of f lfier material__-_ /_ ��_--_Total len th___.___ i g `6� ------------ Seepage Pit: Distance to nearest welL___�i��__��pistance fro �foundation"___ � � � ` .��i____-___ Distance to nearest loft line-- "-_ L� Number of pits_.____--/ _ Lining material---- '/ rpm w-Size: -Diameter-------�-�`-' ---Depth-- �.�"_--'---------------- Distance Cesspool: from nearest well_________________Distance from foundation------------------_.Lining material.......... ____ __"-__ 171Size: Diameter-------- ---------------------------Depth------- Privy: Liquid Capacity -- ---------gals. Distance from nearest well------- --------------------------------Distance from nearest buildin Distance to nearest lot line- g----------- Remodeling and/or repairing (describe):_-___ Gl` __ - ------•------- ---••--- ------ ------------------------------------------- -------------------------------------------- --------------------------------------•---------------------------- -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ules and regulations of the San Joaquin Local Health Disfrict. (Signed)------------------------------- i /,1 r - ----'��----`---- ---------- ----•------------- ---- er d/or Contractor) ------------ BY:-----------•---- ------------ --------------------------------------------[Title)----- ------ --------------------- (Plot plan, showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY ------------- APPLICATION ACCEPTED BY. A/. REVIEWED BY__._.-. DATE - ---- ------------------------------------------------------------ ----- DATE BUILDING PERMIT ISSUED------------ = r - ------ ---------------- PATE-------- -------- ------------- - Alterations and/grrecommendations:__ y — r --------------- -- ------------------ ------------- - FINAL INSPECTION BY:_.-. - ------ �---� v�—� r -------------- -�•-�" Date----- ------�-•-.------ ------ ------------ SA JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaielfon Ave. 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ' Manteca,California Tracy,California F.P.Cp,