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rvR vrrllt u3c: ----------------- -------------------------- ------------ {la -----------------_____.__.___.-____.__ _ . _ ._ _._-- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ------------------------------ (Complete in Duplicate) ------------------------------ ------------ ----------- 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 -a . dThis application is ma a in compliance with County Ordinance No. 549. ' escrbed. �0z '? A /u -V! �ce DQ t - 4Lo JOB AD5RSv . D LOCATIONf-_lY,?rr,E ..�1/erH. -- --N-_-- _� _. �[.,r , ST __�_p ��sa f c19�!!Sr Owner's Name-------•-- Address cer = '�-TlYI!9•Nc Phone. -- ......---. 'A �l_ :�a --------------------------------------------------------- Contractor's Name------•-----•-- ----- Phone------------_--------- Installation will serve: Residence ® Apartment House E] Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms _a.--- Number of baths ........ Lot size __--�Vy__ACA --Lc ' -_ : Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam N Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes 9 No ❑ FHA/VA: Yes ❑ No 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____ll W_,6Distance from foundation----gip.._.___.Material--___.Calx-ca? [� AeVnO� No, of compartments----------- -----------Size__/;�-_-_3L_S_ Liquid depth---- --. Capacity.../$_sa_c>.-- - 1` Disposal Field: Distance from nearest well--�' 4� Distance from foundation.___ /a. .Distance to nearest lot t line__-.. /_- l?� Number of lines_______________+ __ ----- _Len th of each line_.- ,, � �D ..Width of trench.._._._._____.-_LR`/;------_•--- g Ri�+►�--- - Type of filter material__,-A_,�cC_Depth of filter material--------nom .......Total length______-------IVs.- Seepage Pit: Distance to nearest well___ ___Distance from foundation_______--__________.Distance to nearest lot line__._-ys'_ ___ -i Number of pits---------------------Lining material,----=-----------------Size: Diameter----- ------Depth-----------------------------•--. Cesspool: Distance from nearest well------------_----Distance from foundation--------------------Lining material__._-____-_-______---_____-- Size: Diameter---.---------------------- --------_Depth----------------------------------------------------Liquid Capacity gals. J Privy: Distance from nearest well________________________ -------------------- --Distance from nearest building------------• ❑ Distance to nearest lot line -------•----....--------_---. r� Remodeling and/or repairing (describe)___________________ _ -----------•----------------- o ----------------------------- ------------------•------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. • r� r I (Signed)--- -- -V' !-_-- �Q -- � fy--- ---- ----------------------------(Owner and/or Contractor) BY: -------------------------- -----------------------------------------------------•---------------------- Title _ (Pl of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D PART ENT USE ONLY r APPLICATION ACCEPTED BY - DATE- ATE �I.. -- -- -- ---- -- -- -- ------------- EVIEWED BY----- -- ._ ------- - =---------- ------ DATE.-------•--- UILDING PERMIT ISSUED--------------------------------- ---------------- DATE ' Alterations and/or recommendations:--_---..__-____._.__ ---------------------------- ------- ----------------------------- ------------------------------••------•-- FINAL INSPECTION BY- ----- ------ -- ---------------- Date-------- -- �.f`-- SAN JOAO IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 REV19ED B-59 F.P.00,iM a-Go