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rUK Url-IL-t USt: 3 -------------------------__ .-------.------------------- APPLICATION FOR SANITATION PERMIT Permit No. _1y.�6� it -------------- ------------�-r----------------------' (Complete in Duplicate) r #.f I This Permit Expires 1 Year From Date Issued Date Issued Application is'hereby made to the San Joaquin Local•Heblth District for a permit to construct and install the work herein described. This applicafion is made in compliance ith County Ordinance No. 549. ,E JOB ADDRESS AND LOCATION __ - -- --------•------- .......---- Owner's Name 1---" — hone_��_'a�`� . � Address_____ _ 4 _______ ______ Contractor's Name---- ------------ installation ame Phone. 6 ,�/Sf i�. Installation will serve: Residence ❑ Apartment House Commercial I! �] ❑ Trailer Court ❑ Motel ❑ Other Q!/ Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size --------------------- �!I Water Supply: Public system p Community system ❑ Privat"� Sand Depth to Wafer Table _S-. ft. Character of soil to a depth of 3 feet: SanGravel ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ ;i Previous Application Made: (If yes,date___-----------------) No ❑ New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r YN ( o septic fank-or cesspool,-permitfed4f-=public sewer--is-available-within 200 feet:)' Sepfic T nk: Distance from nearest well-�1---------Distance from foundation__ ' No. of compartments --------------S;zes )<"/-6----Liquid depth-----�----------- - _- _Capacity_��C3f�- - ®� Number prom nearest well Q___J� Distance from foundation__! ___ -.Distance to nearest lot line_.--_____. Disposal Fiefd: Distance fr lines____ i - - ------ _ ----Length of each line_��.Q-�_�`._____.Width of trench------�---.--,-__�------------- Type of filter maferialt_ .�QC/ _-Depth of filter material---, r4- -----------Total length-__._.__,/_,Q,e�__---------------- II Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-.__.___...-____ ❑ Number olf pits----------------------Lining material--------------------_--Size: Diameter-----------------------Depth_--------------------- ----------- Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-------------------- ._____-____._. ❑ Size: Diam.aFeter--------------------'_----------------Depth-------------- -------- ------- ------------------Liuid Capacity---------------------------gals. Privy: Distance from nearest well________________ __ -__-----Distance from nearest building - ------------- Distance to nearesf;lot line------ -_-------------------_-_- Remodeling and/or repairing (describe):------------------------------------- --------------- ----------------------------------------------------------------------- ----------•--------------------------------------------•---------------------------- ------ -I hereby certify that Ia - -hr--------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- 4e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SWe laws, and rules d regulations o the San Joaquin Local Health District. a (Signed)-_____________ _ _ (Owner and/or Contractor) - ----------------- --------- ------------- Plot'LL lan, showin- size'of-lo},!' -- -- - -----{Title)--_ -- -- -- B �--r —�. i { p g location of system in rela n'fo wells, buildings, etc., can be'placedon-reverse side)."'. �- —^�--- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -C '---------------------------------------------------------------- DATE-- ----- REVIEWED BY------------------------- "- --------------- DATE------------ - --- �------ --- ---- ------------------ -- -� ----- ------- ------------- BUILDING PERMIT ISSUED------'•----------------- - - ----------------- ------ DATE --- Alterations and/or recommendations:-_____.._------------------------- --------------------------------- ------------------------------------- t --------------- -----------------------•----------- ------------•---------------------•------------------ -------------------- -------- FINAL iNSPETI G Date---- ------------ ._` �~_.,1-� ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Hazelton Ave. I 300 West Oak Street 124 Sycamore Street ' 205 West 9th Street Stockton,California 11 Lodi,California Manteca,California Tracy, California F.P.Co. j�