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IKcarrlUt USE: )00 ---- '- :a _ - �� �. ______________ ________________ APPLICATION FOR SANITATION PERMIT Permit No. _.�(3_LO.�l _ ,t --- ---- -- ------ (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 con uct and install the w rk r 'n described. This application is made in compliance with County Ordinance No. 549. T*� Z JOB ADDRESS AND LOCATION_! t_ .> _� Owner's Name--- 4 s � / t_0 2RAS-1-7-e-4 Sl]�--------- Phone--------------------------- Address - 0----------------------------------------------- Contractor's Name_-�-�-�►�,(-� •---�-f�'� -----------------•--- Phone_�i �� Installation will serve: Residence �partment House ��Number mmercial Trailer Court ❑ ❑ Motel ❑ Other ❑Number of living units: _� Number of bedrooms of aths _� ----- Lot size - 51171-14-1-. -- --- -- ------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ic,T k: Distance from nearest well_________________Distance from foundation-_____.___________.Material ______.________ No. o compartments---------- - -------------Size----------------------------=--Liquid depth--------- - -------- Capacity----------------- • o al Distance from nearest wel • > --___Distance from foundation__et�:47-Distance to nearest lot li _ Number of lines_________ _ ♦ Z410 , � f _ ength of each line___�_(�-Q_�. ___--._.Width of trench_._.__,_f f [ Type of filter material of filter material- ---��_Total length---------------------- Seepage ��d------ v Pit: Distance to nearest well___ ____-___Distance from foundation___________________ Distance to nearest lot line----------------- to ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter----------- -- --------Depth--------------------------------- 11 Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material__-_____...______-._____.______ ----- Size: Diameter Dept h --------------------------------Liquid Capacity------------------_---------gals. Privy: Distance from nearest well---------------------------------- ---__---..____Distance from nearest buiidin 9 ❑ Distance to nearest lot line.-.____________________._____,__________-_._._ Remodeling and/or repairing (describe):_-__ _-..__-____._.._ ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stated and rules and legulations. of the San Joaquin Local Health District. r (Signed)---� �---- I _ _. .�_Al-',>W,-9vc -------- Contractor) By-------------------------------------- y (Title) (Plot plan, showing size of lot, location of s stem in relation to w s buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- REVIEWEDBY------------------------- ------------------------ -------------- ----------------------------------------------------------- DATE ---------------------------------- BUILDING PERMIT ISSUED------------------------------ ------------- ------------------ ---------------- ------------------------------- ---.__ DATE----------- ---------------------------------- Alterations and/or recommendations:______________________ FINAL INSPECTION BY:-------- - ....... ------------------------ -------------- Date_...r -/10-�`5 ------------------------ ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Haieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California