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FOR OFFICE USE: _.----_ _---__ APPLICATION FOR SANITATION PERMIT Permit No. —tee X13 -�3---.�r.��_ i - - --- (Complete in Duplicate) ff - .-. 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 construct and install the work'herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------,---------------- Y-��-P_�: ��`�/ .. Owner's Name `/! = �-,C �J �,f �i ��r. ---------------------- ----- ------------- ------------------------- Phone---------••--------------_ Address � 1 d �t -------------------------------------------------------•---------------------••------------ S Contractor's Name-- --I------------------•--- --•----------------- Installation will serve: Res idenceApartmen House ❑F Commercial ❑ Trailer Court ❑/Motel'❑ Other ❑ + Number of living units: -_ Number of bedrooms �Number of baths _ Lot size Water Supply: Public#system Community system ❑ •[Private ❑ Depth to Water Table Z4- ft. v Character of soil to a depth of 3 feet: : Sand E]if Gravel Sandy,Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ Previous Application Made: [If yes,date----------------------) No ❑ New Construction: -Yes U., No� FHA/VA: Yes E] No ❑ TYPE -OF INSTALLATION AND SPECIFICATIONS: ,. �. ,:" ^��_ r � (No septic tank or cesspool permitted'if public sewer is available within 20Q feet.) 2 ank: Distance from nearest well- - j_--------_--Distance from foundation------------==-_-.Material ------------------------------------------------- Dis o'sal�Fie+ld: Distance from rnearest weII�Y_Q.--t_size----------- --------------------Liquid depth_-__._____.__------------Capacity-.._- [/ tr� his- r ------•---------- p Y N ^ Distance from foundation---P.7_d--------Distance to nearest lot Number of lines-Y-- __________ F Length of each line-_--,� ----------------.Width of ---_ r Type of filter material- t- - - C _ �' '---Depth of filter material---��`_ .Total length------------------------ - -_-_------ Seepa a Pi#: Distance to nearest well__/YWZ/�_Distanc m foundation_ .Q--------.Distance to nearest lac line--/-. _ X Number of pits- __-.-.---_Lining material- QC�-_Size: Diameter---�&- -� p `- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- El _--.-.-__--__--------- -_---.❑ Size: Diameter.- -- ------ --------------= Depth--=----------------------------------------------.--Liquid Capacity----------------------------gals. Privy: ,. Distance-from nearest well_-.------------------------------------------- -_Distance from nearest building--_._._._.------__---- ---------- ❑ Distance to nearest lot line---__._._--__-- k I ------------ ------------------•- ---------------- Remodeling and/or repairing (describe)'•---------------------------- ----------------------- ; ---- -------------•-- - ----------------------- -------------------------- ------- ------------------------- ------------------------------------------------------ i , - -----•--------------------------------•-----------'----------- ------.-• ---------------------------------------------------------------------------------------------------------------r t I hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County ordinances./Sla e laws' and rules and regulations of the San Joaquin Local Health District. ' (Signed)-------- _S- - - -----•I� r- ------ i - ----------------------------------------------- ---------- - -------------------- --- --------i------------- Ow}ner and/or Contractor) ---- ------ - (Title)_. -- t BY' � ----- --------------- -- - ----------------- (Plot plan, showing size of lot, location of system inelation,to wells, buildings, etc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------------------ APPLICATION ACCEPTED BY---- F DATE �3 ------------ ----------------------------------- REV BUiLID NG PERMIT ISSUED --------- ----------------------------------------------------------- DATE----- --------r=--------------- -----•-----=--------=--- _ '`---------- D Alterati nc and/or re�ommenclations:4----- _ .. r- � ATE--C�(C -- LL <� -- G2�.-c_' T " -7 orf' � ,--------- --------------------- -----------------------------------------------------""-------------------------------• --------- -------------•---- r i ?_- op FINAL INSPECTI BY:_L__ .- 9�1Date_- -- - % - -SAN JO UIN LOC HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street '124 Sycamore tree! S .., �* * 205 West 9th Street Stockton,California ' Lodi,California ; >i fjHianteca,Californ,d 'LTracy�'California ES 9 REVISED S-59 3M 3-' 3 F.P.rQ, 4