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FOR OFFICE USE: �I -------------------V ,� APPLICATION FOR SANITATION PERMIT Permit No. Qg -- (Complete in Duplicate) ------ Date Issued _ _._/• � --------_--------__.................... _ --------- This Permit Expires 1 Year From Date Issued Application is hereb krnade 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 AN - ------------------ _-------f - --"------------------------------------ ------------------------------- I ---------------------- --------------------------------' --------= ------------------- Phone------------------------•-----••----Oelame. - ---- Address-------- .......... -f ---------------------------------------- '° Contractor's Name--------- .� �--------------------------------------------i ,/�. ! 4P----;;A901P— -------- ----------- Phone----------------------------------- Installation will serve: Resider a :®r-`Apartment House ❑ Commercial ❑- �, railer Court ❑ Motel ❑ Other ❑ 4 Number of livingunits , �y Number of bedrooms t I O�- -� ��--------------------------- -_-_ Number of bath _�_-_ Lot size _ . Water Supply: Public systemCommunity system ❑ Private ❑ Depth �'o Water TableZQ� ft. ` Character of soil to a depth of�3�.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ `` Previous Application Made: (If;yesdate------------ No Pew Const uAcl3tion: Yes ❑ No �A/VA: Yes ❑ No TYPE OF INSTALLATION ANDj SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: �. � 5 tncompartments, t atwell Distance from foundafiib(n --.` _Material------------------------------------------------- 411V -----------------------------------------.-----: 411V ` No - - - --- quid dep}� ------------------------Capacity --------------- rte,.. �'y _ Disposal Field Numbee,fcoin�ea rest we31..........:..�k__.Distance'`fi•om,foundafi�n__/��`_._______.Distance to nearest lot line_l�__._... • p yP i OP T e of f f lines---.----/ --- -------- -- Length of each,line'---'-- --__--------.Width of trench------------------------____-- a lilter•�meterial __�___ De th of filter material_� ___ ___ Total len th___.__�_•_�__-______________________ See age Pit: Distance � �� p l �� g w p to nearest well_____._' ______Distance #job foundation___ __.__Distance to nearest lot li�_ _____�._ h i� p _-- -- Lining material__ -/. G� _Siz :�Diameter_ Number of its_ --- .-- u Cesspool: Distance'`frcm nearest well-----------------Distance.from foundation.__-----------------Lining material____.---------_------__.________.__- ❑ Size: Diameter------------------------------------- Depth--•------------------------------------------------Liquid Capacity----------------- gals. Privy: Distance.;`from neatest well-- ----------------------------------------------Distance from nearest building ---------------------------------------- ❑ Distance to nearest lot line------- -----------------"------ -------------------------------------------y e Remodeling and/or repairinil g (describe:----------.- 1 ----------------------------------------------------------------- ---------------------------------------------- --------------------------------S--------___________--- _-----_ - I I yt --- ------------------------------------------------------- -------------- ------------------------- s I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, State laws, and rules and regulation's of the San Joaquin Local Health District. (Signed)--------------- ' '"�/ f �<GQ --------- -- ------ --- --- -- ( ontractor) itlot Ian, showing size of lot!" location of system in refa�tiop wells, buil BY: ;p -- --------------• dE ----- -------------(Title), --- --1--------"-----... ( p g y 'dings, etc., can be placed an reverse side). ry ij FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ---------------------------------------- DATE----------- -- -- - - REVIEWEDBY---- -------------------`-`-------------------- ----------- -------------- ---------- ------------- --- DATE------- .......... --------------------------------------- BUILDING PERMIT ISSUED--,'--- --- D •- - --------------------------- ------------------------ ._ ¢ _ wu,g ndtiAlterations and/or recommeaons:__ _ - ------ ti -- --- •- --- ---- --------- --Q. !lPilFllC.1 ,t%�? cu_�}f!4t�C `�"` �� J (U/ JJJ .y FINAL INSPECTION BY:............... 4� �----- ------------- Date-------- -��A -- ------------------------ --------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Striet "k,'124 Sycamore Street 205 West 91h Street Stockton,California +i Lodi,California ` �'Manteca �California Tracy,California F.P.0 C. • � dA