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FOR OFFICE USE: ---- --- ---- Permit No. ... __ .�.7-- ...---.. APPLICATION FOR SANITATION PERMIT _ ------------- L----- _ 4-- ------------------------------------- (Complete in Duplicate) ,a . 1 Date Issued------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. _ JOB ADDRESS AND LOCAT ' �~ lt l - P-h on'e -------------------------- Owher's Name ------ . Col -•----•--------I--•---•-------. ••-----. tractor's Name-------- Phone... r Installation will serve: ResidenceApartment House El ❑ Trailer Court [I Motel ❑ Other ❑ t - lP---•---._----.------ Number of living units: _�'.___ Number of bedrooms _ -- Number of baths -------- Lot size _ l- - - --•• Water Supply: Public system El Community syste ❑ Private•�Dep#h to Water Table Adobe Hardpan Ch! ratter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam i Clay Loam ❑ Clay ❑ ❑ ❑ IM FHA/VA: Yes No ❑ + Previous Application Mader II �(if yes,.d'ate--:- 1 No New Construction: Yes o ❑ ❑ TYPE OF�INSTALLATkON�AND_SPECIFiCAT1_OiJS: A -d (No septic tank or cesspool permitted if public se s is available within 200 fe;44afer-al ° ---t Septic Tank: Distance from nearest well--- 'No. -- istance ffro+ foundation___ r ( •No. of compartments--------- ----- --li' --- i egize-- 1�--7= Liquid depth_- �--------------Capacity.//-- --------- 14 - ---• 3 Dilposal Field: Distance from near es well�_0.__� ante from found !1 istance to nearest lot "'*Z '-^� Number of Lines______ _____ ____ _ _ __ __Length. of each line_ _-__. _ �e idth of trench_._._ -�.__ _`- Type of filter material--- - Depth of filter material__-,- -------------Total length----•----- - •----- r - - Seepage Pit: Distance to Number well---------------___---Distance from foundation--------------------Distance to nearest lot line____--_.____--___ Number of pits _-__ _,Lining_material--------- ---------------Size: Diameter_:--------------------Depth---'---'---------•------------- Cesspool: Distance from nearest-well___________ __Distance from foundafiion_---_____---.___---.Lining material_____--..--___-___.__--.____________ ❑ Size: Diameter--------------------------------------Depth-------------------------------- ----------Liquid Capacity gals. i Distance from nearest well----------- { Privy: - -----------------Distance from nearest building--------------------------••------------_. ❑ Distance to nearest lot line---------------I------- -- _._ ----------------------------------------•----------------- 1 Remodeling and/or repairing (describe)-------- -----------w- ------------------------- -------- - - ------ ------ ---------------- •---- �i4-------:x,t_-- ---------•-------•--------------•------------------• � -° -- -------- ---- --- -- 5 r`--------------- ,. .-- II l hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin Coy ordinances, State laws, and rules and regyulati n of th San Joaquin Local Health Distric#. f�� • ____.-_-{Owner and/or Contractor) ( -- - -- 4 {Signed]_ +_ __M; - ry ri - - _- _..�-. : -------�------------------------' ` "'{Tttl • (Plot plan, showing size of lot, location oUsystem in relation to wells buildings, etc:, can be placed on reverse side). FOR DE MENT SE ON ,� I �/ APPLICATION ACCEPTED BY- --- . . --- = ATE T ° REVIEWED BY-------- --------------------------- -----------------•----- DATE ( --- --.--- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED------•-n--------=----- ------ I j Alterations and/or recommendations: --------------- = _ I I�--------------------------- - -----------••---•-------------- ------------------------------ -- •--- ------- - _ ----------------------------------------•---- ------------ -------. ------------ - Lf I ------- ------••----- •--•------- --------•-------•---- ------ FINAL lNSPECI®M>A�Y - -- -• - ----- --- date - ti -- -.-- SAN JOAQ61N LOCAL HEALTH DISTRICT t) J` -J`'e'wf124-Sycamore4S rt eet 205 West 9th Street- 130 South American Street 300 West Oak Street. b.� r' Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVIBEO B-39 F.P.CO.2M"D