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+ FOR OFFICE USE: 6 z - ---_---------------------- ....... APPLICATION FOR SANITATION PERMIT Permit No. r .f�� =. ._. l --- -------- ----- -------- --------------------------- (Complete in Duplicate) -/�—G Date Issued --------- - - --- This Permit Expires 1 Year From Date Issued -_...._....____ i 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 Cu�ty Ordi o. 549. i } z✓ l JOB ADDRESS AND L CATION E€ ------- Owner's Name ---- ---- ------ Phone e ----- Address ��. - " --- -- / �;, ` u --`�. 1449. Contractor's Nam ------ ____-- ,hone--- Installation will serve: Residence partment House ❑ amia�fercial ❑ Trailer ourt ❑- Motel ❑ Other ❑ Number of living units: I tuber of bedrooms -------- umber of baths _-Y Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe Hardpan ❑ �.........�.,,_._.. PreviouspQlicatian Ma e: [If yes,:date....................j No ❑ New Construction: Yes ❑ Na FHA/VA: Yes ❑ No ❑ TYPE O INSTALLATION AND SPECIFICATIONS: (No se tic tank or cesspool permitted if public sewer is available within'200 feet.) 1 41 S is T Distance from n arest well________________Distance from;jo_undation-_----______- ___.Materia --------------------- ------------------------- t No. of compartments------ --------------- Size-------------------------� Liquid dept ....capacity----------------------- . e �1_=_.Distanceto nearest lot line field"_ Distance,from nearest well -. .VLO-1 Distance from foundation__ _--__ /1 ------ ------ Number of lines4___ �__-- ___ - Length of each iine .f_.�_ _-___Width o trench .�1C`� -_ f__.___ Type of filter mater _ .. _ .__Depth of filter material _,- f Total le gth________________ _ { page # Distance to near st well _ _ Distanc om oundationr___._ Distan�c 'to nearest I t line .___..119_ Number of pits_ _.: -------------L; material-�� ____...Size Diametefr__Z.,3__-. ___Depth_________________ ' Cesspool: Distance from nearest well----------- Distance fro oundation__ ________ ____L'ining r terial-------------------.____._,.____-___. ❑y ------------- Deth -- ----- Ligwd GYapacitY gals. Size: Diameter_:___ __.. ._ p - - Priv Distance from nearest well ,__ Dis#'ance from nearest ling----- ❑ Distance to nearest lot line---------------- ------ I--%*-----)._ �--- ---r --- - _ Remodeling and/or re pairi9 (descri4�e)T-`� ------- ---------------- ----------- --------- - -`-- -------- ------------ -------------- •- _ _ i -------------- -- ------------------------- --------------# ---- ) ---- - li { ---------------- t ------------------------------- -------�:----------------- --- --- - ---•----- ------- 4'' ------------------------- ----------------- --------- ------------------ t - Ir herb certify that I have re k - ------r -. =--------------------------t------------------------------------------. ordinances; -- ------------- y y prepared this application and that the Fork w1lltxbg;,done in accordance with San Joaquin County Slate I w and rules—and regulation f the San Joa uin L&cal ealth,��Dis+ric+� (Signed ¢meq �-' -0` -` Contractor) By:-,3 ` � Tale {Plot plan, showing size of lot, location of system in relatio welts, 6uildi�ng c., c b}placed on reverse side). i { FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY--- ��- - = Vit '------- ------`-------------------------- DATE."- - -=�//--- ------ REVIEWED' BY ' ------ --------------------------------- -------------------------------------- DATE----------- BUILDING PERMIT ISSUED-----------t---------------z_---'----------- ---------------------------�-------------- DT�.� ---t---------- f ----------- Alterations and/ori Cr#recommendations!a' ---- ---- ............ ----------------------------------------------- =_ �-- --- ----------- I'- -- ----- � /--�- ---�-- ------*---- I - -------�-fl yam- -�-----------------�------- --------------------•- -------- ----------------= - ----------------------------- -- - - ---------------------------------------------------------------------------------------- '' s - '----------------------------------------_---- --------------------------- {... -------- -------------------------- --------- -------- ------ ------------ -----------------------------------------`-"=---I ------------------------- ------------------- : s - � == Dat / FINAL 15 I N B :................... . -^°^ - SAN JOAQUIN LOCAL HE LTA H,DISTRICT "r.r..,...we+rr 7601.E�Hazolton„Ave�..�. .ter ,. 300+Wesv0akrr 5 eet 124•Sycamore-Street �.r:.205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California w F.RQU. = d 14