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rUK VrHC:E U5E. - ------------ '-CSO - - ---- ? - ......___... ---------- 1 APPLICATION FOR SANITATION PERMIT Permit No. .....Ze ----------- ------------------- ------------- -- ------ (Complete in Duplicate) � --------- '--- -- ------ ----------------- Date Issued - - ..--- This Permit Expires 1 Year From 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 LOCATIO I(O -_-.- O Owner's Name---�'"-�---•--b� - _ _..._ _ ------------------•-•---------------- --------------------••----------•--•------------------------ iL x- -: - ----- ---------------------' ---- Phone--------------------------------- fAddress.,------ ---•-- ....._. � n` 6 ---------------------------------------------------------------I...........-._------__-_.I......... Contractor's Name-------------- Phone...... -------------------- ----- - Installation will serve: Residence g?-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..f Number of bedrooms -Z�P_ Number of baths 1.--- Lot size , , 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 r - ®�New Construction: Ye &-no ❑ FHA/VA: Yes �o ❑ �,� 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----- -____Distance from foundation_-.rp / r --------.Ma�rial- -�--L.� -� h /y f / -------- No. of compartments--- - Size.< �--.lC ll@-------Liquid depth-- ----------'-----Capacity- ----------- 1 Disposal Field: Distance from nearest well-__7�----- Distance from foundation[`_ _. ._ ---------Distance to nearest lot line_--._. r � Number of lines-1----. ......... Length of each line... _. �---- 9 '-�--- �,-----..Width of trench.t�--1 ----- - ---'------------ Type of filter material_/--_ .L--_-Depth of filter mate rial_- ---------Total length----- ---------- Seepage Pit: Distance to nearest well ---_------Distance fr m fo dation._.. e-------Dista�nf e to nearest lot line-.4---/--..- Linin material--�� -Size: Diameter---SSle- �}y [?� Number of pits g -------Depth 6 Cesspool: Distance from nearest well-----------------Distance from foundation-- ----------------Lining material_____---___.___-- ❑ Size: Diamet ------ -------------- ------------ ' " Depth ------------------------ Liquid.CapacitY --------.gals. Privy: Distance from nearest well a _----- .-Distance from nearest building-- --- ❑ Distance to nearest l"o#-ht ---_'.----------'--------,-'- nY --- ------------------------=-==-------------------------------------------•-------------- -- r -- rRemodeling and/or repairing (describe): - ----------•-- ----------------- t v �� p •---------------------------------------------------`- .. _ . . _ .if I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County j�ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - ------' -- - - - ----.(�d-Lor Contractors BY:----------------•-----------------------•----`- ---------------=--------------------------- --- ---- ---(Title)--- J �-'-'- t�' (Plot plan, showing size of lot, location of system in relation to a s, bui dings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY ' ,i4PPLICATION ACCEPTE�BY _ . -------- " -------------- DATE----�Q REVIEWEDBY----'-' --- -- - --'- - --------- - -'------------------'- --------------------- ----------------- DATE------'---'- --------------------------------------------- - -•----------------------- BUILDING PERMIT ISSUED ------ DATE----------' ------------------------------------------------- Alterations and/or ___--,-A•-------------- 1 114 ------------ �- - - --------- ------- --------- -------------- ------------------------------------------------ ------------------------------------------------ ------------------------- ------------- ------ ----------------------------------- --- ------------- --------------------------------------- ------------------------- ------------- ------------------- -------------------------- -------- FINAL INSPECTION BY:� --------- -----:------ Date--- ---- -------------- SAN -- ' 'SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, i f 300 West Oak Street � � � � �•�,`'.'� � '- � 124 Sytamore�5tre�t 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c;O.