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UK --r�` IC;t 115 s _ - ------- - --- --- --- ----------- ---- ------ APPLICATION FOR SANITATION PERMIT Permit NO. . ( �a � ----------- ---h' (Complete in Duplicate) ' -------- This Permit Ex fires 1 Year From Date Issued Date Issued _6___3/`—__�z/ 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 --------"-- -L-OCATION_��__�_�_-� ----------------- ---- •----------�------------------------ --------- � Owner's Name _• ------------ ---------------- ----- Address_.......... ----------- --- --------- ---- -- -------- ------- ------- - ---- Phone---------s ---------- --- _---------- --..._ - ----- Contractor's Name_______ ------------------------------------------------------•------------ R_ � � = -� ----- --------• --------- ------ -•----.._. Installation will serve: Residence [Lji`gpartment House (] Commercial ❑ Trailer Court ❑ Motel [] Other ❑ it Number of living units: Number of bedrooms __ - Number of baths "_/_ Lot size ----- ---------------------------------------- Wafer Water Supply: Public stem -----------------•- y [Community system p Private p Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Previous Application Made:.y (If yes,date---i----___--_-----) No ['� Hardpan E]TYPE OF INSTALLATION AND SPECIFICATIONS: New Construction: Yes ❑ No D�FHA/VA: Yes El No El septic tank or cesspool permitted if public sewer is available within 200 feet.) it nk: Distance from nearest well---------.-------Distance from foundation__________ r ' ---------.Material-------- �------ ------- -------- �------- -�, No. of compartments-------------------------- Liquid depth------------ ------- ----Capacity--------------------_--- Disposal Field: Distance from nearest-well -.Distance from foundation__--/S-------Distance to nearest lot line_____-. 1 Number of lines._______._". Length of each line !�.' - 9 Width of trench Type of filter material_!- -"o-G/� Depth th of filter material-__ _�_-"----Total length_______--___"-------�4 SeepagDistance to nearest well-� ---Distanc r foundation___ ___---_.Distance to nearest lot line .......Number of pits..._._. --__------Lining material - i Size: Diameter.--_--- 3.-��----Depth------a_s'_--- Cesspool: Distance from nearest well-_______________Distance from foundafion-..___"--___-----"".Lining material_-_.--__...___.___""--_--___---_-___ ❑ Size: Diameter. -- Depth - ` --- -- --- ------- - -----Liquid Capacity- -------- ----- ----gals, Privy: Distance from nearest well___ ------------- ��:`' ,Distance from nearest buildin ❑ Distance to nearest lot lire-------- ----- --- - - ------ ---- g---------- ----------- } ------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------- ---------- ----------------------------------------------- -------------------------------------------- ---- ------------------------------------------ --------- -----------------------••----------------------•----------------------------------------------------------------------------------- I hereby certify that I have prepared this applicatio and that the work will be done in accordance with San Joaquin County ordinances, St laws and rules and egulafions of the l an Joaquin Local Health District. r (Signed)----- . ____________ _------____________________-_____ -_._-_____-____._.._---___-_-____-.-______fc:d . . P caner an r Contract/o or).m, z ----------------------------- - ------{Titl(Plot plan,•showing size of lot, location of syste en relation to wells, buildings, etc., can be plrt reverse side-- + FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---s_-__-._ -i_ DATE ` � 3/ ---------------------------------------- �------------------- - EVIEWED BY------- - ---------' � _ ------------ -------- -- ----- - - -- DATE---- BUILDING PERMIT ISSUED ; - ---------------------------------------------•------- Alterations and/or recommendations: 3/_ rl1 ------- A E ----- -U------ �.. Com' / r7- r --- - ----------- ----- ------------- 1 -------------- ---- ---- -------- ---------- -------------------- - ----- - ----------------------------------------------------- ----- --------------------- -------------------- FINAL fNSPECTION �_ Z7/ ----- ------ ---- -------- Date----- ---- ----- ��- ---- -- �-------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT J 1501 E.Naselton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California P.P.c o. E ' d