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rvK VrN : U4t; ------------- -----=----------------------- ------------- ----------- ---------------------------------- ---- ----------------------- ---------------------------------_ ___ APPLICATION 'FOR SANITATION PERMIT Permit No. _ - .. . (Complete in Duplicate) i �+ --- --------------------------------- - ---- ------ This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for-a permit to construct and install th _o here herein goscriL}ae�d. This application is made in compliant with County Ordinance No, 549. e JOB ADDRESS AND LOCATION__'_ �f Owner's Name----------------- - Phone_--- --•-------------- -- ----- one--•--------•------------••---------- Address........ .. . ++.�•.. G' N. - --------------•-------------------- Contractor's Name• ` 8• ��----•------ f r� r� ----------. Phone-3- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other Number of living units: _-/---- Number of bedrooms Number of baths _ .�� `�[,! '� ❑ ---- Lot size- Water izeWater Supply: Public system ❑ Community system [] Private Depth to Water Table __._.___ f#. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C] Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date---------_,_.__...} No New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within:20U feet.) . .y._.. _ Septic k: Distance from nearest well___ Distance from foundation__ _-0---•----Maternal.....No. of comp artments-------�------ --- Size � _10-------Liquid depth_------------------ Y .. CapautY / Dispos geld: Distance from nearest well__.._ -1!2-- 'Distance from foundation___ - �_Y----Distance to nearest lot lin Number of lines_______ Length of each line---------_--------------------Width of french.____: Type of filter material__ _ G7 Depth of filter material--__._ -_ ,_-_-__._Total length__________ __ _ 4 / l Seepage Pit: Distance to nearest well_-__.._-______-____-Distance from foundation-----------___-_-_.Distance to nearest lot line-________-__--- N ❑ Number of pits... Lining material -------Size: Diameter- -------- --------.Depth---- ---------------------------- i esspool- Distance from nearest well_________________Distance from'foundation-------------I----- Lining material__._____--_____-----_____-_____-- �f ❑ Size: Diameter--------------------------------------Depth----------------------------- --------- ----- ----Liquid CapacitY----------------------------gals. Privy: Distance from nearest well---------- ___--________- _______-___--Distance from gearest building---------------------- -------------------- Distance to nearest lot line ------ ---------- Remodeling and/or repairing (describe):--------- ________-.- -- t i -------------------------------------------------------------'--------------------------"-;-_-------------------�----------------'�--------------- .._.-_._..- -- ' ! hereby certify that l have prepared this application and,#hat the work will be done in accordance with San Joaquin County ordinances, State laws, dy les and r lations of the an oaquin Local Health District. , (Signed) -- -- --------- ,------------------------------------------- ---------------low By:-------- -•---- • - - ------------ ----- ------•--- _ ac (Own an o orttr tor} r - ------- -------- --------------(Title}----- (Plot plan, showing size o lot, location of system in vela#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y.. APPLICATION ACCEPTED BY-------- _----------- _F ---w--- ---------------------' --------------- DATE-------- 'I ----------------------------------- BUILDING �6S�~ -------------------- IEWED BY----------------------------------- --------�----- --------.----- -----------_: -- _ DATE------------•--------------- ---------------------------- BIJILDING PERMIT ISSN.IED--------------------------- - -------•;---------------------- _ --- ----------- DATE .Alterations and/or recommendations:------------------_------ ------------------ ------------------------------------ -•------------------------------------------ - -_ _ ______________________ _ __________________ ___ --_.--_____ _ .. _________________________________________________ ----- . .--------------------------___ z _ ------------------------------------ -------------- __________ ___ 7.n. FINAL 1NSPECTIbN = -- - ----- ------ --- ---- --- Date---- ------------- SAN -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 ES 9 R£VISEG 8-So 3M 3-•S3 F.P.M3. �I _ t