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E 1 _ J FO OFFICE USE: ermit No. l tL•----`- APPLICATION FOR SANITATION PERMIT. i (Complete in Duplicate). x i , . 3� / ---------------------------------- ----------__-- --- _ .. . .. Date Issued' �¢/..�/ !(-_--__---"-_ _ "-----------------___---I� -_ I This Permit Expires 1 Year From Date Issued' ; _ ' Application is hereby made to the SanJoaquin Local Health District for a permit to construct and in alit work herein described. _. This-application•is made.in compliance with County Ordinance No. 549. r ( JOB ADDRESS AND ......... + � lr I 'd J. Phone O War's Name -- = = Address --------------------------------------- ----------- 11 - '� � Cs�f• (�=—� : a_... ------"-" I) i > �p K. -------------- Phone---------------------------------- contractor s Name__. --: !�d?R 4 Installation will serve: Resilience Apartment;House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other,❑ � /_ Number of bedrooms e�.; N e '-of baths __C___ Lot size .__s6--� ---- Number of living units:-;-'-/- - - umber Water Su I Public s stem Communit s stem, ❑ Private �epth to Water Table PP Y ft. W,. y l �.. y ,:Y Character of soil to a depth of 3 feet:, Sand [IGravel ❑ ;Sandy Loam;❑ Clay Loam El Clay El Adobe []^ardpan C1= ll I I Previous Application Made.-:, [If yes,da#e__.. ) No, } New Construction: Yes [�No El FHA/VA: Yes A-, No El� Y TYPE OF INSTALLATION AND SPECIFICATIONS tic Tank: Distance..from nearest well__ 4� Distancvailable.within feet.) (No septic tank or,.cesspool permitted if public sewi er s'a Sep e from fou 'Septic -Za _ a ---- Material__ _ -�-- w No. of compartments- --- j T Size �� _4-jF_T_iquicl depth-_'_ °--------------Capacity/.; t . Distance from nearest well___?AO------Distance from foundation___ _o ��_-.Distance to nearest lot line_s _�___. Dsposal�Field Number of lines____.--__—rZ - ..---- ----Length of each line.......... ---.-.--Width of french__,Z_-` D Type of filter matenaI__: � Depth of filter material____-- ---------Total length----- ---------------=------ p 9 � .1 See a e Pit: Distnabee,to nearest well_.___/_ Distance from fo dation___ _Distance to nearest lot line ___. . . ----Lining material__x0_; -- / of pits__._ SiSize: Diameter ._. �_ .. Cesspool: Distance.from nearest well________-__.----Distance from foundation____________________Lining material__..1�-___.--___.___f_______-.-. 1. ❑ Size: Diameter -------- ---------- ------Depth------------- ---------==---- ---------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well___---------_____________-___.___--------.-----Distance from nearest building_____ ________________ � Distance to nearest lot line------------------ --------------------------------------------------------------------- il Remodelin and/or repairing (describe): ----- g -- !1l ------------------- ------------ - ( _ --------- t - ---- --- - - _- ! hereby certify tha{ I-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules/And regulations f the San Joaquin Local Health District. ' r Contractor] (Signed)---- ------ --- ------ ---- ------------------ ------ '1 (Title) BY:-------------------- • ---- _ -- e r [Plot plan, showing size of,lot, location of system in relat' to wells, buildings,.etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY = r .. i APPLICATION ACCEPTED BY-- ----- ?Z DATE y :r !!! .. s REVIEWED BY------------------------- --- DATE t BUILDING.PERMIT ISSUED-------------------"-- f ----- ------------------------ s DATE= 1 Alterations and/or re omrnendattons:__ — �`�' !�0 -1 -"""" �--------- �---��--------- �--E--•----- ----��-�-�_--�--�--�-• '`-ate`- —�C .___��----�__ -�__-__�_--- 1 II �j` . •-- -------------------------- ------ -- � ... .. Q - - z _ !I ------------------------------------ ---------------------------------------------------------- �-� "Date----------- FINAL INSPECTION BY:. SAN JOAQUIN LOCAL HEALTH DISTRICT " 1601 E.Ma:elton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,Californid 1 Lodi,California, ,.,_ Manteca,California Tracy,California F.P.0 O. CS 9 REVISED a-59 - ,