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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. Cam]ete in Duplicate) . 2 -------------- - : ..; PA - . , w�_Date.Issued - -T This Permit Ez ires 1 YeaE-From 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. - 7 JOB ADDRESS AN LOC TION--- f�LY�.4i✓ _ _.rl_- - #------------•------- Owner's Name --�.1_-•---- -- --------- ------------- Phone-------------------- --:: d Address------------------ �.� — - ..il --•-•--------- ------ f � Contractors Name y ---•------•------------•------------- ---- ----- Phone---------------_----------------• f Installation will serve: Residsncejj'� Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units.- _l____ Number of bedrooms:--_ Number-of baths ___�_ Lot size -----�_;� �/�'-� ------ ----------- ------- Water Supply: Public system ®/Community system ❑ Private Water Tablec,S-ft. s Character of soil.to a.dep+h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E:] Clay Loam ❑ Clay E] Adoberdpan ❑ Previous Application, TYPE OF INSTALLATION A(If yes,date--_-___ _-1TNo~ New=Coristruirtion�Yeso,❑ l HA/VA: Yes ElNo�� on_Mader NWSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_________________Distance from foundation-_- -U__ _._Material.-_�._�__:��-�'"�-G--�``.-.---"-- No. of compartments-_______2r -------Size__. --X-.V-t2____-__.Liquid depth---4i_%. Ca p acit y...F,7.0.0-_-_---_. t Disposaield: Distance from nearest well...... ---__Distance from foundation----1��'_.f_._.Distance to nearest of line---- -----...__. Number of lines.--#____�•r------- -------".___Length of each line___-��__'� ��-.Width of french-__ �_-1!--.--___----____ Type of filter material------ � !}L --Depth of filter material-- t .----"--Total length---_ See a Pit: Distance to neares well____-- .--s- _ DistCyo and tion__ _ p g� -/_0_--____.Distance to nearest lot line-- --------- NumbeNumber Depth_ -1'� � r of pits_--------------------Lining,.mateize: Diameter___ `pCesspool: Distance from nearest well--------------_-Disfoundation-------------------Lining material-"____-----__-._---._--__:-----_-_. ElSIze: Diameter.---" --------------- ---- -----------Depth--------'-----------'-�-�r" ---------- -== Liquid Capacity - gals. I Privy: Distance from nearest well------------------------------------------ _*_D•rs ancebfrom nearest bui{din ❑ Distance to nearest lot line ------------------------...__..---------i------7--;-:-•------ Remodeling and/or repairing (describe)--:- d` .-,�---------------------------------- -----------------••------------------------------------------------------------------------------------------------•-------------------------- -------- - ------------------------ -- ---------------"-----------•------------------------------------------------------------------- - ------------------------ -------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �7 (Si ned _ 5 } RO -� 3 _ ----------------------- (Owner and/or Contractor) BY ----------------r-----------------(Title)-----C� ^, -------- ------------ (Plot plan, showing size of lot, loco+Ibn of y tem to relation +o wells, buildings,.etc., can be placed on reverse side). �r f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --------------------------------------------------------------------- DATE------fes REVIEWEDBY----------------"---------------------------- --------------------------------- --------------------------------------------- DATE BUILDING PERMIT ISSUED - - - DATE--- AI#erations-and/or veto mendations __� -_ _-�44�-� 2'-� - -- - - -�____ r. - -�__�C` t - 1'__Gs-------------"` ----------- --- -- --- F'--~ ------------- !�- -------% el• R/a/y - _______________Y.lS__�-__-_..____.__ _ _.._._____ __."! =`�, -_-__ _- ` _._ �.. ' •,'4-__ .s1_--f- .�{ _.f_-_-.._ '---C--_- -_----_--..- -------------- - ---------- FINAL 'INSPECTION BY:------- T- ---------- ----------------- ------------ Date-------- - .- - --------•---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.flaxelton Ave. 30_0 West Oak Street • 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f