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--------------------------- -------------------------- --- . a --------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- -- ---------- -------------- (Complete in Duplicate) - --------- --- I. This Permit Expires i Year From Date ISSLfed 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. >� Z� JOIi ADDRESS AND LOCATION- ___,1k-4 }", 4 Owner's Name------- i C�-� = ------- -- ----- Phone------------- �_c� -------------- Address -_f ? ='u "i----------------------------------------- Q61ractor's Name------- ..----- - I-L R .jC ------------ Phone.. ---------------- Installation will serve: Residence E[- Apartment Houte ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ r f. Number of living units: ----: Number of bedrooms Number of baths -_ 2,-- Lot size -------- -o--PCZ/cU ,';Water Supply: Public system ❑ Community syste�❑ Private [�^ Depth to Water Table ,p_rft. -f Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 13 Hardpan ❑ � Previous Application Made: (If yes,date___ __________ ) No New Construction: Yes ❑ No FHA/VA: Yes El No E-. !,,TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest well �' -----------------Distance from founds#ion--------------------Material------ -.----__.-----__--_-_-_- " t No. of compartments--------------------------Size------------------------------Liquid depth--------------------------Capacity- ,:... ---------- - Disposal Field: Distance from nearest well' ` _JA ____Distance from foundation----� ---�..-.Distance to nearest lot line-�`----- --------_-___- Number of lines------------ --------------------Length of each line-:Ldp SrQ_�-------Width of +rench...- - -------------------- \ , ��.,, ®® f \� Type of fitter material-__-.v_ .______Depth of filter material-__1_rY ---Total length--_--_ 'L_------------------------ ------ ` Seepage ? p ge Pit: Distance to nearest well------ 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-------------------- ----------------- El Size: Diameter------ ---- ----------- Depth-------------- ---------------------------------Liquid Capacity-------- gals. Privy: Distance from nearest well------------------------------------- �, ..�. _ - ------------Distance from nearest building__-.-__-----_------_--_--__.- . _ ' Distance to nearest lot fine��_�- _- _�' ...,, --------------------------------------------- Remodeling and/or repairing (describe�:T__��-_ 4 1, = b . -- ----------------- ----- ------ --------- --- ------------------------------------------------------------------------------------------------------------------------•------------------------- -------------- ------------------- ---- I hereby certify that I have prepared this applicatioriand that the work will be done in accordance with San Joaquin County \ ordinances, State laws, and rules and regulations ofjhe`.San Joaquin Local Health District. f (Si sed � � � 9 )------------------ ---- ---- -- - " - ---------- ----------- ------------- -------------- - ----------- - �---{Owner and/or Contractor t • ------- ----- r -=�-=Y=---`= -— ------=-=_--=-----=---I~Ti+le)'---------------- -:__. - - (Plot plan, showing size of lot, location oisystem in relation to wells, buildings, etc., can be placed on reverse side). t AV;L, FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED SY----_F1_8.O ,- -_ DATE__ ------- ----------------- REVIEWED 8Y ------- ------------------------------ ------ DATE N BUILDING PERMIT ISSUED -------------- ` `= -------.- DA•TE- ------------------------------------------ Alterations and/or recommendations:--------------------- .___ ------------------------------------------------ ----------------------- -- -------------------------------------------------- ------------------------------------------------------ ------------------------ �'--- -1----------- - --- --. ---------- - t ------ - - T- - - ---------------------- - --------------------------------------------------------------------------------- FINAL INSPEC BY { Date--- -- ----- SAN ---SAN J.OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Califarnia Tracy,California