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Il.G UoC: .— t _ APPLICATION FOR SANITATION PERMIT Permit No.��----;eq ---------------- -------- --------------- (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 LOCA ON_ _ � --- �+- wner's Name r7 ----- Phon r --- ------- --------•---------- --------•------------1-------•-•---------------------------- - a "--""" -""" -/-- Contractor's Name_ "� " { Y N------ Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J.____ l,N . ber of bedrooms _ -__ Number of baths ___ ___ Lot size __-__ Water Supply. Public system Community system PP Y' Y y ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Cl Y ❑ y ❑ dobe hardpan ❑ Previous Application Made: (It yes,date___-----------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.pe_rmiffed„if,�pubiic-sew.er�is-arailable_w_ithin-200__feo,) Ze r- Dis#ante from neares# well___ ante from foundation r I - .� -- -- --- --- Material. No of compartments l___--- - Size --------- ---Liquid depth--- Ca acit ----------- _, = - P Y l Dis'ante from nearest well4�,..is tance from foundation_---y Number of I•rnes.__._� ""ky��"- � �?____-Distance to nearest lot line___"-. .--"-- _ _Length of each line--/- 47-!`__---- Width of french---CQ_46�!_ _1 0 >r-- Tye of filter material` G] dF Depth of filter materiai_._._�.__/._----___-Total length------ 7f �''�--_�" S pa Pit: Di�ance to nea e't. well_._ } 01 Dis ante rom foundation to nearest lot line___ Number of pits._ r ---------Lining material_ v r - ¢ C _ _ - Size: Diameter_ - ` ------ El --- Depth - .j a Cesspool: Di Lance f m%n ar'e:well_--- tt #R ------ ___---bis#ante from foundation------- ---- _ inmg materiaL�----------------------"--p_--- -- i ❑ Size: Diameter _ Depth----------- r '`�' ----- ----Liquidt✓apacit ) ' Priv %r Y 9ais:, Y 'Distance fr m rnearest w L - :----------- :- ---- pistannce from�nearesfi hui7din - ❑ ----------------------- V11 Distaceto neares}lot line._.__-_- g ) j Remodeling and r re airing (descr�be�:-__- -- --------------------------------------------- - ------------------- ----------------------------- ------------------------------------ - �.;. --- - --'--- L"' • ---- -- -------- Y,,,--- - -------------------- I hereby certify that l have prepared this application and#hat=the--work will-be done in'cordance witli'San Joaquiri'-C )unty ordinances;State laws, and rules nd'regulations of the Sa Joa uin Local He th District. (Signed)-- ---• Qr--- �l"-Gy ` `� (Plot plan, showing size of lot, location!of system in relatio o wells, building , etc., can 6e placed on reverse side}. ( FOR DEPARTMENT USE ONLY t t APPLICATION ACCEPTED BY--------__-F._-- Z� DA7E � � REVIEWED BY .- DATE BUILDING PERMIT ISSUED------------------ ------------ - DATE-- Alterations and/or recommendations:__-�_ -_ r ---------- - ------------------------------------- I -- ----- ----------- -------- ------- ------------------------------------ -----•--- ---------------------------------- -------------------I---------------------------------------------------------------------- ----------------------------------- ------------------------- --------------- --- = --------- ------1 ------ -- -- - ---------------------- ------------------------------- - FINAL INSPECTION BY------- --------- - - ---- ------ --- ----- Date ----- ----- ------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r•.a.c n.