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rvK url-I-t USE: ---------------------------------------- ---------------- ------------------ --------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. Ql' ?' j - ---------------------- ------------------------------- (Oomplete.in Duplicate) r7"' - - "------------ ------ - 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 nd install the work7heg de cri ed. This application is made in compliancew_it_h County Ordinance No. 549. JOB ADDRESS A CAT N `-- �� - ---G- ---�------ Owner's Name""_-__-" _ 0 - - ------------------------------------------------------ Phone"" ---- ---j°"+z��"�± Address--------------- --- / Contractor's Name____ _�• F' Installation will serve: Residence OC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: --l--__ Number of bedrooms J--- Number of baths I--- Lot size ---<--�� r �4© � /Y �/ � F Water Supply: Public system ❑ Communitysystem GJ J� ' y ❑ Private Depth to Water Table "eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, " Hardpan ❑ Previous Application Made: (If yes,date"--__.-" _--__-J NoA New Construction: Yes U< No ❑ FHA/VA: Yes ❑ No f ' TYPE'OFTINSTALLAT-ION–ANDTSPECIFICATiONS- ---.;.r.. —, - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well !p_f__Distanc�ro un ion-/40--'r hh No. of compartments------7._----___--_-Size-_-- """k _Liquid depth__-__x�."-__- _ Capacity-/ — Disposal Field: Distance from nearest well__-�f-__Distance from foundation"" Q"-_-"_-". f--- Distance to nearest lot line."" � I Number of lines"--"""�__ __ � , �-------- Len th of each line___- g �-- -----------"---Width of trench----�----____-- - Type of filter material---a 4-----_Depth of filter material__-� _ ---____-"Total length". _02-0--a_/-------------------- Seepage Pit: Disfance to nearest well-_/00---------Distance f m foundation A `"""_... to nearest lot� Number of pits--- -s -----------Linng mafierial"_ �9y110N 5_._ .Size: Diameter._.. ". De th ---- p Cesspool: Distance from nearest well"""_""" - m Size: Dameter _- foundation___-_.- ------- Lining materia l-------------------------------------- - tl --------------Depth------ -------------------- -- ---------------------Liquid Capacity------------------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building M ❑ Distance to nearest lot line.-"___.-__"__-"""-____-"-._"-.-.".____" ." Remodeling and/or repairing (describe):------------------------------------ ------------ -------4'1—f----------------•------ ----------------------- ---------------------------------------•------------------ -------------------------------------------•------------------- -------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ^:--------------- .. M -- ---:------ - - Y ---- _ —_._._ _. _ .-..�.�-, �-_-�.,�..�. .._.-..,�-. -�� _._ �.�(Owner and/or Contract By:------------�--- -— - . (Title) (Plot plan, showing size of lot, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ." ----------------------------------------------- DATE..---- REVIEWED l ' -- -- - --------------------------- Y------------------------------------- ------- ------------------- -------------------------------------- DATE BUILDING PERMIT ISSUED------------------------•----'---- --- ----------- DATE ------------------------------------ ----------------- Alterations and/or recommendations:.-_------------------------------- ------------------------------- ---- - --------------------- ---------------------------------------------------------------- FINAL INSPECTION BY ------- ------------ Dater�/.- �"". G" ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 6.Hazelton Ave. 300 West Oak Street 71 112 4 Sycamore street 205 West 9th Street Stockton,Califorrela Lodi,California Manteca,California Tracy,California