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rUK UrrIC,L USE: — — --� APPLICATION FR:SANITATION PERMIT Permit No. ------ -------------------- ----------------- -- (Complete in Duplicate) ------ -- - .R This Permit Expires 1 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___--C�"-"3_ --------- ------------------ Owner's Name---A - ------ -- ---- -----------�---- ------- a - ------------------------------------------------- Phone_AI_f r- f4t->- Address-- -.1111111,_AS7 --------- -- Contractor's Name---------- ---------- ...---•------ Phone----•--------- Installation will serve: Residence ff-Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms___ Number of baths --/"- Lot size Water Supply: Public system .N Community system >K Private ❑ Depth to Water Table 4 0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,k Hardpan ❑ I if Previous Application Made: [If yes,date-------------_------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 44 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r r� Septic Tank: Distance from nearest well________________Distance from foundation_.._______"_______.Material,....__"_____ I ❑ No. of compartments------------ - -----------Size--------------------------------Liquid depth-------------------- - ---Capacity---------- ------------ Disposal Field: Distance from nearestyell- a/YFDistance from foundationti- .` .Distance to nearest lot line--_�+'�__f____ ® Number of lines--------Y� __ ___ ----Length of each line_____�' .Q_�__� °' -Width of trench,_ -"'�--------- __"-"--- Type of filter material_ " _a�_____ '---__:Depth of fifer material----ZR..........Total length________ Qd----_______-________ Seepage Pit: Distance to nearest well.-_,0%4'�_-Distance from foundation-P--'.4-- a-_/10__.Distaa cce to nearest lot lin}e_�______._ 19 Number of its'__/._.. _Linin material, C .etf-__size: Diameter.-,?--?__________ _ P g `i -Depth- - i Cesspool: Distance from nearest weft-----------------Distance from foundation-----------.-------Lining.material__.______..________.____-_.__.______- ❑ Size: Diametdr--------------------------------------De th-------------------------------------------------- Ca acit P .-Liquid P Y- - ---------------------gals. Privy: Distance from nearest well_____________ __Distance from nearest building----------_______- ❑ Distance to nearest lot line------------------------------- Remodeling and/or repairing (describe):_f___._A44 - ,G , --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------- ------- 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 ruler. and regulations of lbelSan Joaquin Local Health'District. , (Signed)---- L c -------- --- ---------------------------- ---------- -(Owner and/or Contractor) By. --------------------------------------------------------------------------------------------------------------------------------------(Title)-------------------- -------- ----- ------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EPARTMENT USE ONLY r APPLICATION ACCEPTED BY------A�17 --_-- ----------------------- �2 DATE--------1---.REVIEWED BY---------------------------------- ---------------------------------------------=------ DATE------------------------------ BUILDING PERMIT ISSUED----------------------------------- --------------------------- DAT Alterations and/or recommendations:._ "_— . _:. ,� ''- ----- -r-"_____� �` - ----- ¢ rod --------/ ------------ QZ ------------ -------- --------------------- ------------------ ------------------------------------------------ - ---------------- ------------------------------- ---------------- - ----------------- - -----"--------------------------------------- ------------------------ -----------------------•------- ---------- -- ----------------- --------------_------------- -- _--- -- ------------------------------ ------ ----------------------- --------------------------- -------------------------------------------------------- ---- --------------------- FINAL INSPECTION BYE. - -- ----- -- b Aate /JO�A�IN LOCAL HEALTH DISTRICT 1401 E.Nazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.R.co.