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t rvKUr;li✓t USE: F APPLICATION FOR SANITATION PERMIT Permit No, ------- ----------------- (Complete-in Duplicate) I --------------- --- --- This Permit Exfres 1 Year From Date Issued Date Issued , 1 y �7 Application is hereby made to the San Joaquin Local Health District fo a permit to construct end install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO TION i „7A1S:7 � _ Q4 i Owner's Name -- -a� - � >� ."� Phone Addressa�.s _�+r� -------------------------------------------------- ----------------- ' Contractor's Name_-D�/�"�R,,_______ ------------- --------------------------- ---------------------. Phone.--------------•------•----------- Installation will serve: Residence 91 Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ -- Number of living units: "/ - Number of bedrooms Number of baths .-- Lot size _ """ Water Supply: Publics stem S y ❑ Community systemrE-12rivate ❑ Depth to Water Table ------ - ft Characfer:of soil to a depth of 3 feet Sand Gravel Sand Loam Cla Loam Cla ❑ Y ❑ Y ❑ y ❑ Adobe p Hard art Previous Application Made: (If yes,date------------ -------) No �ew Construction: Yes o ISN [IFHA/VA: Yes No El j; TYPE OF INSTALLATION AND SPECIFICATIONS: LL '(NO"-septic tank br`cesspool perrr►itted if public sow r is avaiiableWWifhit5.200 feet:)'- — SepticTank: Distance from nearest well-..7 -Distance from foundation". " C"p r^ No, of com artments_--_ f�----------.Material.-- .�.-��:��---- -•- p -- ----------- Size"`�_X_2 Z`---------Liquid depth-"'>.�.--- ------ -----.Capacity---�QQCp -----,-- pisposal Field: Distance from nearest well... Distance from foundation---. JP---------Distance to nearest lot line.""""5_""".."_" \ .: Number of lines-_--_--,_3--" [) << ., Length of each line"-..""s�___ ... Width of trench...... Type of filter material--lR CK------Depth of filter material......Idt --------Total length------ '55-0 - ------------ Seepage Pit: Distance to nearest well----10Q--------Distance from foundation---.CQ"-------- Distan e to nearest lot line----------------- Cesspool: _.�_--"-"""` Number of pits.-- ----3-------- Lining maferial__RQ.C1�-__ Size: Diameter_" ."--. ,f f�,( � -----Depth �z:--------- - ; Cesspool: Distance from nearest well "---------------Distance from foundation__--------------- ..Lining material"-._._."-__---------," r ----------- Ei ❑ Size: Diameter. .- Depth ------------------------------------------Liquid Capacity---------------------------gals. .:. Privy: Distance from nearest well-------------------- ------------ ------------- "Distance from nearest❑ building ----------------------------Distance to nearest lot line ------ ---- Remodeling and/or repairing (describe)------------------------ --- " ----------------- -----------•---------------------•-•-_-------------- ---------------------------------------------- -------------- --------------------------------------- ------ ---------------------•--------- ---- __ _ --------- -------------- ---------------__------------------ ----,-----•--=--------------- ----- --;--------- ------- ----- -------- .- ----- , I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,-SfSfa�telalaaw�s,, and rules and regulations of the San Joaquin Local Healfh Disfrict. (Slgn8d)•---"`-'•'`'1_v'-"51` - .----/�Y r 1 - ------------ , _. "`--lel _ - caner and/or Contractor) BY -------------------------------- --------------------------------------------------- -----------=- — ------------------------ --- - - ------ ------- - --- ---- ------ ------------ ----------- ------- C� �r, (Plot plan, showing size of lot, location of system in relafion fo wells, buildings, etc., can be placed on reverse side). FOR DEPA 4JENT USE ONLY r APPLICATION ACCEPTED BY- DATE- / --- ---------------------- -- REVIEWED 'BY .......... --------------- --•- DATE ----------------------------------------------- BUILDING PERMIT ISSUED._-,-- --.------------------------- " --_--------------- -------------------------------------------- DATE .---------------------- Alterations and/or recommendations:.- -------- - ----------------------------- ------ - ........ -------------------------- FINAL INSPECTIO -L-_ Date--- SAN ate"..SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California "'- Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press 1 i A