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N-./1% vrrI%-r- V5[: �� i� 4� ----- -- - ____-____am-- APPLICATION FOR- SANITATION PERMIT Permit No. �;L T ------ - --------------------------------------- (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 LOCATION_---33 4 _ --- ---------------- ---------------- ------------------------------------------------------------------ Owner's - ` D� Name _ - Phone `� Address � ------ -- ------ -- •---------------Q---------------- -------------------- r Contractor's Name---- -_ - ------------------ 0---Apartment --------- Phone_ ... f Installation will serve: Residence House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/- Number of bedrooms _4- Number of baths _ Lot size U' - - _ --__ / S _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table !;�7tft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe 9?---Hardpan ❑ Previous Application Made: (If yes,dgte_/.?!�-3------I No ❑ New Construction: Yes 91< ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S pt", nk: Distance from nearest well_________________Distance from foundation-------------------Material - No. of compartments_____ ____. Size Liquid depth- ----- -------- ----Capacity------------------ Disposal Field: Distance from nearest well- _ -..._ 'r .. / Distance from foundation.--_ _ -.-__.Distance to nearest lot line___. __-___-- L� Number of lines----------- ____ _ __________Length of each line___ 9 11-4- --------------Width of french-------�- --------------------- -----_Total length--------- --- Type of filter material.-_ % !?_<t�-Depth of filter material-----1. �� ---------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line___:-_______-..El _ W Number of pits---------- -- --------Lining material------ --- ----- ----.Size: Diameter--------- -----------Depth------ ---------- ---------- _ s Cesspool: Distance from nearest well-----------------Distance from foundation._. --------------- Lining material------------- .___-_.___-________.__ ❑ Size: Diameter----- --------------- ----------------Depth---------------------------------------------------Liquid Capacity ----.gals. Privy-, Distance from nearest❑ well______ S __________ _ _____-_--- ---- ----__.-__ building--------------------------------------- --Distance from nearest Distance to nearest lot line-----_--------------------------- ----- -------------------------- Remgdeling and/or repairing (describe:_-___ .0 / � y --------------•------------•-------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to,�anddrules laws, nd rlatians of the San aquin Local Health District, (Signed)----- -- -------- - -- - ilil� fJ - _(Ow er and/or Contractor( BY:-------------------- 11� ------------------(Title} (Plot plan, showing size of lot, location of system in re la on to wells, buildings, etc., can be p ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-_.__._-__ / DATE-- -- --- '3- REVIEWED BY----- ------------- --------------- ------- - ----- .... ----------------------------------- --------------------------------------------------------- UILDING PERMIT ISSUED----------- ------ -------- -------------------. DATE.------------ Alterations and/or recommendations:-------------------------- --- ------------------------------------•----------- FINAL INSPECTION BY:---- ------e`e------------------------------------- Date-- 7/£7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California