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.9.� rVIN k.)rn _t Uot: ._ APPLICATION FOR SANITATION PERMIT Permit No.�_ ------ ---------- - - (Complete-in Duplicate) - This,.Permit Ex ires 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. # # � r a JOB A 1.DDRESS AND LOCATION____f-.'A R]� / _A jOwner's Name.-= � �°�® .T� ------5_1*kk7 ---------- . � _C ]--0, ------- ii NAddress--------------• � . -I -C------ ------ Phone ---------------- -------�--t.•- � `--- ��n ----.�Contractor's Name S •------------ ___...._-_ ------------- -'-- Phone_Installation'will serve: Residence El Apartment House ❑Commercial; Trailer Coup+ 11 Motel El Other Number of living units ❑ c __ _._._ Number of bedrooms - __-- Number of baths_..__-__ Lot size _- G? � Water Supply: Public system 2 Communit s stern t- - --------•------------ Y y ❑" Private-❑ bepth to Water Table 70_ ft Character of.-soil to a depth of 3 feet Sand ❑ Gravel ❑ SandyLoam ❑ Clay Loam [] Clay ❑ Adobe ' Hardpan [] Previous Application Made: (if yes,date- J No ; ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF lN5TALLATION AND SPEClFICATlONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-14JO ` & ,Distance from foundation_ 3 No. of corn pa Mate�ial __�rQ. Cl _. ,, p .I ---Liquid depth--� IN- `- ---- ---- CaPauty_�Q�l�_ � Disposal Field: Distance from nearest well/V0A1 _Distance from foundation__ .__.--- --- •Distance to nearest lot tlljne__ .�---. Number of lines ---- Length of eachdine=/457C � t t Width of trench--+ -•_- Type of filter material_ K--_---_Depth of filter material---�--�------ ----Total length------la_Q6_----- I Seepage Pit: Distance to nearest well-Ail-WE----- from foundation _ ZNumber of its....�►-: -----.Distance to nearest lot line-_S--___-.,. P '��-.-------------Lining material._.----'" Size: Diamefer--- tf Cesspool: Distance from nearest well--------------___Distance from foundation _. ..Lining material Size: Diameter- -- - -- - ----- -- --- bepth' N Liquid Capacity -------- ---------- ala. Privy: Distance from nearest well_____-'""::- ---_- ------------------- --------Distance from nearest building❑ Distance to nearest lot line g ----------------------------- ------------------------------------------ --------------------------------------- .. Remodeling and/or repairing (describe):_._._S. 3' " --------- :�t - --- - - - ------- ------------------------------------------------------------------------ hti - - y ---------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .� ordinances, State.4aw3""aTed7Gl s and:regulations of the San Joaquin Local Health District. (Signed) ' $ --- --- ----------------------- ----- ......... .(Owner and/or Contractor) - (Plot plan, showing size of lot, location of s stem in relation to wells, -- - - --- - ---- - - .---------- - Title ------ - - •r. buildings, etc., can be place on reverse side). �4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_C;; W REVIEWED BY---------------- DATE__ DATE-- --------------------------------------------- -- ----- , BUILDING PERMIT ISSUED -------------:--- ------ --------- -- ----- -- ---- -------•-------------•------------------ ----------- ---- - - DATE -------------------------------- Alterations and/or recommendations:_-_____ - F _ _____________________._______.___.___._..__....__..___...__._.._____.----------------- ----------- ------�----Y/---' Date. FINAL INSPECTION BY• � -- --•'-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 ti,Ha:olton Ave, 300 West Oak Street 124 Sycamore Street Stockton,California Lodi. California 205 West 9th Street Manteca,California E.H.92M 1-67 Vanguard Press Tracy, '• California