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fUK0111(;E USE: ;I t $ --s- 1--------------------a" 4��I : APPLICATION. FOR SANITATION PERMIT ----- ---------11,11elpv---- Permit No. ........................ 1C ------°=-------------------------------------11---- omplefe in Duplicate) &_ ...... ---- .......... Date Issued This Permit Expires 1 Year From Date Issued - ------- ------- --- Application is hereby made.9;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 - --------- ----------- - --------------------......--------- -------------------------:--------*--------------------------------------------------- Owner's-Name-----/0---------- ---------- ---------------- --------- ------------ --------------- --- ---------- Phone------------------------------------ L Address hone------------------------------------ Address--------- 0- f` /Z �.-� Contractor's 0-Contractor's Name________ -------d------ IL --------------------------------------------------------------------- Phone._YA__5 .._ � _,3------ Installation will serve: Residence R' Apartment House E] Commercial Ll Trailer Court E] Motel [3 Other 0 Number of living units: __f---- Number of bedrooms Number of baths---/---- Lot size ------ ___`1--___X ---------------- Water Supply. Public,.system' R;j,Community system E] Private F] Depth to Water Table -------- ft. Character of soil to a depfh'i�of 3 feet. Sand E] Gravel E] Sandy Loom El Clay Loam 0 Clay [-] Adobe Kj- Hardpan C] Previous Application Made: 1�{If yes,date_________________-.] No g]-- New Construction: Yes i�No Ej FHA/VA: Yes E] No E�- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifh;n.200 feet.) Septic Tank: Distance from nearest well-A±t-v-,_Distance from foundation---Lq----- -----Material---- Er No. of compartments_-__--__ _______---Size-__ Liquid dep."th------Y----- - -- ___-Capacity____ff ---- -- Disposal Fiefcl: Distance'4rorn nearest well_1Va_j,.--c__Disfance from founclation_'_Z�_---- -_.Distance to nearest lot line---15 -------- Number of lines---------2-----------------------Length of each line-------Yr tq-"_.V�------Width of trench---___ ----------------------- Type of filter of filter material-----U ------ -Total length--------- --------------------- N Seepage Pit: Disfancellfo nearest.well__/r- Distance from foundation----�_o----------Distance to nearest ]of line_--)--—------ Number"of pif.s:'-.--/- ----------Lining material----/?--k---A-_.Size: Diameter-_--1!-'r-... .....Depth__4_J__1------------------- a it Cesspool: Dist�nce'lfrom-nearest well_______-_-- ---Distance from foundation---- --------------Lining material__._...________-____-_-_----_____---_. ❑ aterial__.-------------------------------- F-1 Si a'm e-ter--------------------------------------Depth----------------------------- -------------:-------Liquid Capacity--- ------------------------gals. LA Privy: Distance4r,_m --------------- --- - ---- Distance from nearest building------------------------------ ------------ ❑ Distance jfc, nearest lot line-------- ----- - Remodeling and/or repairing (describe):---------------------- --------------------------------------------------------- -------------------------------- ------------•---------------------------------------------------------------------------------------- -------------- ----------------------------------------------------------- -------- ------- -------------------------------- --------------------------------- -------------------;------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ------- ------ -------------------------- -------------0---------------------------------------------------------------------------------------------------------------------------------------------- -------------------- --------- I ------- I hereby certify that I k�ve prepared this applicafion and that the work will-be done in accordance with San Joaquin County ordinances, State laws, a rules and regul tions of the San Joaquin Local Health District. (Signed)---------------- ------- ----------- ----- --- ------------------- -------I------------ ---------------------(Owner and/or Contractor) By:----------- --------- -- --------------------------------------------------- -----------------------------------(Title)--------------------------------------- ----.._..----.-------- (Plot plan, showing size of l'` location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- .-I--------------------------------------------------------- ------------------------- DATE__ -a-7/ REVIEWED BY------------------------- --------------------------------- - ----------------------------------- ------------------ DATE BUILDING PERMIT ISSUED_-_ ---------------------------------------- -------------------------------------- DATE------ Alferafi d/ orn d ti T/rk no/or ec 7encr, i --------- ---------- ------------------------------------------------ ---------------------------- -------------------------- --------------- ------------------------------- -------- -------- -------------------------------------------------------------------- ------ -------- ..-------- -- ------- - --------------------------------------P4 --------------------------- 1� _ ----- � ------------------------ ---------------------- --_------------------------------------- ----------------------- ------------- ---- ------------ --------------_----------------------------------------- ------------------------------ -------------------------------------------------- ------------------ --------------------- I. FINAL INSPECTION BY:.-' Date--------- ji SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave---:" 300 West Ciak Street 124 Sycamore Street i,-205 West 91h Street Stockton,California q Lodi,California Manteca,California 'Tracy,California C.