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rUKUt-HU USE: "V ' r - 'c �` �- t 19¢ (5 0?"7 0 T` ------- ----------- ------------ ----------------------- ` ----- - ------------------------------ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------- -- --------------------- --------------- (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. 54_4,.f JOB ADDRESS AND LOCATI N. --- --- __� .------ .�-_,---- -------------- _ __- -------r 1��__/u--------------------- 1� �4-pS---------- ! Owners Name ----------------------- _:_ Phone_ Address------------------------"-aS--AXE771-----�-ss 1 p Phone_ - ld. .7 .. Contractor's Name S_D ... - J '--------------------------- Installation will serve: Residence rl Apartment House Commercial al Trailer Court p ❑ ❑ ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms _?/. Number of baths -1-___ Lot size -&--z..-X--_/- - Water Supply: Public system �[( Community system ❑ Private ❑ Depth to Water Table-S{_ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N" Hardpan ❑ Previous Application Made: {If yes,: ate--------------------) No New Construction: Yes ❑ No)Kj FHA/VA: Yes ❑ No W`1� TYPE OF INSTALLATION AND SPECIFICATIONS: \, (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) l z Septic Tank: Distance from nearest we4-AkNafDistance from foundation_. 0-----___.Material----_ . _ 4 ----- --------- { �, ; No. of comportmems.___-�_______ --Liquid depth---..�r.._z--...__.._ ._ Capacity- Distance apacity �Q �r Disposal Field: Distance from nearest well.-_-.___.---.-._Distance from foundation--------------------Distance to nearest lot line---.__---_------- ❑,'1di 541'A)C Number of lines-i,---------------------------------Length of each line------------------------------Width of french Type of filter material-------------------------Depth of filter material--_____-.---___----.__Total length__._._.____________. --------------------- Seepage Pit: Distance to nearest well--------------___-----Distance from foundation--...___----_-_-..-.Distance to nearest lot line---- --__-_-__- ❑ Number of pits. -------Lining material------ ---- -----------Size: Diameter-------------- --------Depth----- ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------- Size: ------------- ❑ Diameter--- ------------- -------------------Depth----------------------------- ------- -------------Liquid Capacity-- ------------------ -----gals. Privy: Distance from nearest well--------------------_-------------_._._.___ _= pistance from nearest buildin 1 9 ❑ Distance to nearest Int—lir+e Remodeling and/or repairing (describe)____ ----- --------------- � ----- ---- f t r -- --------- ---------------------------------------------------------_ - - ______________________________________________________________•_---_-__.__-------___------__.-_.--__.-__-.--_----____-__-._--_...__-__------_--__._.__-_.._-- I hereby certifyVand�rules ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laand: regulations of the San Joaquin Local Health District. (Signed)By 0... '---- -- --- ---------------------------rh----- Owner and/or Contractor) y: � ------ , I r t - � ------------ ------{Title)--------f- � r[�-4 -------- (Plot plan, showing size of lot, location of system in relatfon to wells, buildings, etc., can be placed In reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B . ....... ._----------------- REVIEWED BY DATE �0 a`I�- - ------------------------------------------------- ----------------------------- DATE 1 BUILDING PERMIT ISSUE ------------- - - - - ------------------------------------------------------------------ DATE Alterations and/or recommendations:------- --------------------- ______________ a -------------------------------------------------- ----------------- ---- ---------- --------------------------------- ----------- ------------------------ ------------------------------------ FINAL INSPECTION BY:-------- - ...- -�' -rJ . Date.----- ------ ---------- --a----�1--"-- ----------- ------- -- - -- AN OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California i Lodi,California Manteca,California Tracy,California F.p,CC.