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I 0-L URIC; � l j ----- ------•---- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------- (Complete in Duplicate) -------- ------------ --------- ----i--- This Permit Expires 1 Year From Date Issued Date Issued .cq gApplication is hereby made to the San Joaquin Local Health District—for a permit to construct and install the work herein described. Ti,is,application is made iYA fiance with County Ordinance No, 549. JOB ADDRESS AND LOiON___-C_c'v $v_+_rr Q"rk w ? - - Owner's Name__. - . = e_j y- rl'1�-1'0-_, __ ---------------- -- ---------------- Phone = Address_-___-_----•---__-_----- �+�'Q ADDRESS Contractor's Name------•- LSF= �R -CRSTlN ----------------------------- --- Phone--------- -----•------- Installation will serve: Residence I�Apartment House El Commercial E] Trailer Court ❑ Motel [) Other ❑ ,. i Number of living units-__Number of bedrooms _. -_ Number of bathsL-_.l____ Lot size _-_A.ay-e _ �. - ..I Water Supply: Public s stem }'� - r ' PP Y y Y❑ Co�munify`system ❑ Private 0'" Depth to Water Table - -2&-ft-Character of soil to a depth of 3 feet: Sand R' Gravel -1 Sandy Loam E] Clay Loam E❑ I Clay El Adobe ❑ Hardpan ❑� Previous Application Made: (If yes d ate------------------._) No'9 New Construct io is Yes k-No ❑ FHA/VA: Yes ❑ NOW,, t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic farik'or cesspool permiffed'if-public sewer is available'wifhin'200 � feet.)-- from founation_,iSeptic Tank: Distance from nearest well__ ---------Distance __1r-- ` No. of compartments-.----------�--------Size_�_X�t�-6----_-_Ligwd depth.....�---------------Capacity__-jos'}�-----• � Disposal Field: Distance from nearest well---Fq_- ..._Distance from foundatt n-_•_R$__--__.Distance to nearest lot line___-_----- u Number of lines-------- .�° -. Length of each line.�� tt'249C.Width of trench __aZ ------- ---- ------ Type of filter material-_ ae,i< 11'" ' t �41 4-'--�-- Depth of filter material_-__ . .t_ Total length _._-- �--/2-C?---- Seepage Pit: Distance to nearest well________________ . Distance from foundation--------------------Distance to neparest lot iine----------------- ❑ Number of Pits-__.-- Lininmaterial-- --- ---------- - Size: Diameter---•a--- -- - -----De to--------------------------------- { Cesspool: Distance from nearest well---- -_. ---Distance from foundation__.______-_- )Lining material_._____________________________-_-_ ❑ Size: Diameter ----------------------- - -------Depth---------- ------------- f iquid Capacity----------------------------gals. Privy: Distance from nearest well_ I <----------------Distance from nearest building--------------------------------------- -- 1 . ❑ Distance to nearest lot hne..--------- - ---- ---------------------- Remodeling and/or repairing (describe) --------------------------- Jx � ' t 1 ------------------- ---------------------------------------------------•------•-----------------------•------------------r---------------------------------------------- + i lc ---- . -: - ----------------------=--' ---------------------------`-------------------------------------------- IF I hereby certify that shave-prepared this application and that fhe work will be done in accordance with San Joaquin County) # ordinances, State laws, and .rules..and egulations of the San Joaquin Local Health District. - w ;----� (Signed) ------------- ------ - -- -- ------------ - - �___ ' -------------------------------------- ---------(o wrier and/or Cantractor)! 8Y=• == --- _.." " (Title)_- ..! ----=---- ---= -4 -�(plot p an, showing size of lot, location of system in a ' n tings, etc., can be placed on reverse side). i ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ._. i.F ,- - - ) ------------------------------------- DATE.-------`,L-?[? — T I - -- ------------=----------------- - a - - --------- --- -- ---'------------- EVIEWED BY ----------- ----------- - - ------------------------- DATE BUILDING PERMIT ISSUED------ 6 - - ------------------------------ - DATE- ------ terations'and/ar recommenda`tions:�.._� _— °�-� -�-*►•-• •�-- --------------------------- --------- -- ------------------------------------------------------------` ~..-�---- .� ,T�.4 ..� �. ------------------- 2p p F x r jtA_ _ R -r`-o*--^f-F_a Dt?li=D R --------------- ---------------------------------------------- ------------- FINAL INSPECT ._ - ---------------- d�`l f Date--- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazelton Ave. 300 West Oak Street 124 Sycamore;tree) F 205 West 9th Street Stockton,California Lodi,California Manteca,California - - Tracy,California F.F.C 0, r