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jar y '------------ - v ------- } APPLICATION FOR SANITATION PERMIT Permit No_/_�l�_-. (Complete in Duplicate] ----------------------------------------- This Permit Ex fres 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 X N. Owner s Name------- -------- == ------------- f.mss L �.�, � = Phone I Address_. �- ............ ---••------------- rP,. Contractor's Name------------------•-----•---- ©� -- .... -- ------ ---- -- - - - ------- ----•---- ---------••-----•----•- ------ Phone.,.--------•-----••---••---•-•----- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer C I � Court'❑""',Mo I ❑ Other E] Number of livingunits: __.. Number of bedrooms `""""'}T �NumbeT of�baths -- - Lot size -------------- --------------------------------------------- Water Su I Publics stem Communit s stem Y� y / I Y Y ❑ Private ❑ Depth to Water Table ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Cl��HA/�VA: be and an Previous Application Made: (If yes,date---------. _ r t ) No New Construction: Yes ❑ No Yes Io TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if publictsewer is available within 200 feet)�,�r Septic Tank: Distance from nearest well "-¢---__ / .. Distance from foundation --_----.Material._" -- -- ?/r� �i I -e I� /1N[No. of compartments p._t -- Size `_�C y -Liq d depth 44TT -------Capacity.. l Disposal Id: Distance from nearest7weU_..•• ,_ -__pistante from foundation / Distance to nearest lot•line . ------- Number of lines------- - s / Length of each''lme- Width of trench--a-0-. ------------ ! /�� 3ype of filter material.__jj _. C<'Depth of�fiiter material_-- -K----- / r. _,.. - Total length �-------------------------- f Seepage Pit; Distance to nearest weiL"............... .. .. stance, o fo dation-__e t - _ ..Distance to nearest lot line-l��-�,. /�f�� Number of pits__. .--_----Lin n. material.. _J!L 9 /.- _ _ ,Size: Diameter.--2�;---------- Depth_. ` Cesspool: Distance from nearest well----.------------Distance"from foundation__-._--_ Lining material--__- Size: Diameter --�---------------------- ---------Depth(------------- ------ ----- - - -- ------ ---- ---Liquid Capacity----------------------------gals. T------------- ( Privy: Distance from nearest well_._._...__...__....__-"-.} Distance from nearest buildingEl Distance to nearest lot line...... Remodeling an or r iri {describe):.__ " -----------4 and .. -- �. o I ------------------------- ------•------------- - ordinances, State laws, and rules and re his a -- ;-------------•-------------------------------------------------------------•-------------------------------------------- � I hereby certify that I have re Bred this application and that the work will be done in accordance with San Joaquin County 'regulations of the{San Joaquin Local Health District. I (Signed)----------------PO-40------------- -Y?-D------ ----- ----------------- -------------- ------(Owner and/or Contractor) By:------------------------------------------- U (. (Piot plan, showing size of lot, loc 0 .of SYeam inrelation to wells, bui mgs, etc., can(be placed on reverse Side, FOlt DEPARTMENT USE ONLY ` "� '"�' APPLICATION ACCEPTED BY---_-- .u • - --------------------------------------- ------- ----------- -- DATE-- --- -- ---- BUILDING --- 7 -- REVIEWED BY--------------- -- � -- ---- - - ---------------------- ----- •----- ------ DATE------------------------------------------------------------ ; PERMIT ISSUED----------- ----- i ----�_-----------_"_.-- - ------------------------------------------•-------------------------------------- Alteration and/or recommendations:." '. DATE ------------------- - " y � Pte• a r �! ----------------------------------------- - . � ' T-- .•= - ------------- ----------------------------------------------------------------------------------------------- --------------------- ---- ------------ ................................ _-- f / .."- FINAL INSPECTION BY:------- � ----------- Date - - -- -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California C•P.CO.