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Y�x 6�(-t ust: Z ,. . � s�� A 11 • ------- S/0 w �/� ----------------------- ----------- 3 ' APPLICATION RFOR'SANITATION PERMIT Permit No. _------------------ ... F (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 construct and install the work herein described. This application is made in compliance with County Ordinance .No. 549. JOB ADDRESS AND LOCATION•_ _ J' ?�rx 7`� -�-� �! ` Owner's Name------ d _ / ------ Ph ---- - Address----------------- = __ f Contractor's Name----- _- __ cirl: ' __L r-" ------------------------------- ------ Phone- K:_:p Installation will serve: Residence Apartment House W. Commercial ❑ Trailer Court E] Motel El Other ❑ Number of livingun,its ,�,4;,�N,..umber of bedroom Number of baths __- ff s v ---_ Lot size -_--- f � _ - Water Supply: Public system Community system ❑ Privatefi3O Depth tc Water Table -__---.-ft. 4 a Character of soil to a dep}h=of 3 feet:-r-Sand:] Grave_.❑„�„Sand.y.,Loama❑,;,Cla,y.Loam ❑ CIa-,y*D,,Adobe Hardpan [] at r Previous Application Made: {If yes,dale-..--.__-------_---) No ❑ New Construction: Yb s ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public�sewersissavaila6le-within.200 feet! y # SI I1�Q� ,+► l � 1 Septic Tank: Distance from nearest well__-- --____-__ � " t Dist rice�rfr�om foundation---=---•----- Material------------------------------ -------- ❑ No. of compartment(--------- l• 1 pe Aqui pth_ - Capacity,---------------------- Distance ('� w f V' Dis osal Field: from nearest well �._..--..-=Di stance from foundation.___-_ .�' .-�._-_-Distance to nearest lot line----/�___•. AA❑ Irxf uS Number of lines-- st _ ! jr h �1` �p YP � 9th of Ilse-_ `'�_ �--.Width of trench- ---- ;�% --- l Type of filter material--_ 'r �` D,epth{of ilfe matena11__.__lk_ _--___f otali length---------- _f _---___ Seepage Pit, Distance to nearest well.-- -- "-____Distance from foundation 11 ---_ --_-_.:Distance to nearest lot ..- ws Number of pits------ -_ -_ -.-_ Lining material--- .SfZE}. Diameter.....3e_ f�t esspoa : s Distance from,nearest well,_- --.._--__--I-Distance from foundation----.--1-----------Lining material--.-----__------------- ------------- i 4 5ii Dia:eter- 1 , 'terDepth_ ': �.--__ I g F -------------- �liquid Capacity-----------------------------gals. Distance edesf Privy❑ Distance tooneareat 1 t Ilnle---- _ - --_......Distance from nearest building. ---------------!--- °►" :1r�� s-.r7, CSF 'IR�?�= r.��b"Re,:---/f�._ '--�-Remodellng nd orjre a°irirr d�9t�seri --------�--- -�.-�'�--� - r-�-- -------. -- I 10 t ------- - ;--;.Y 4 ------.a--------------------- ---------- 0--------------------------------------- - ------------ 1 hereby certify that[ ave�preper�ed thisxapplicati n=and that the work will be-dons a 'In actio dance with San Joaquin County ordinances, State laws, and rules and:regA igns of the San J ao at Health Disfrict. (Signed) - ---- ----- -------= - -------- ------------------------- t . ` � --` --- - � {T'--- ^--- {Ow and/or Contractor) $y:------------ = l r ne -- ------ -- - ------ -- -�---------- -- ------------ ---------- the_ Plot plan, showings' a of lot, cation f sy�em in rela}ionito wells, buildings, etc., can be placed on reverse side). ' ' FOS§"DEPARTMENT USE ONLY g APPLICATION ACCEPTED BY_.____--_ __ _-._ — � .--- -- ---.----------------- --DAT E VIEWED BY k f y/ l ' --- - -- I •DATE_..---------- -- '.d BUILDING PERMIT ISSUED--------------- --------------- --------------------- TE----------- ------- --- DA ------------------------------------------------ Alterations and/or recommendations:_-j....:.....................: .. .. ... - -----------------------•------------------------ ----- -----•------------ ------------------------------------------ ---------------------------------- ----------------------------- ----------------- - --------------------------------- FINAL INSPECTION SY: ------` - ---- Date- SAN ate SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,California Manteca,California Tracy,California