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M4F�R, T -----------------'"- ------------- --------------------- ------ APPLICATION FOR7 SANITATION PERMIT Permit No. Q` ^ --------------------------------------------- -------- (Complete in Duplicate) This Apphca#ion is herebymade to the San Joaquin Local Health District�From Date Issued Date Issued -�-=�G__�� This application is mde in compliance with County Ordinance No. 549r a permit to construct and install the work herein des ibed + � .. ....- JOB ADDRESS AND LOCATION_ 40 Owner's Name__-__. �"- - ��,----A-•---"-, .y Phone. / Address-_. - [s r - _/ � � Contractor's Name-------11 ---------.------------------------------------------------------------------------- Phone---------------- •----- Installation will serve: Residence. Apartment House ❑ Commercial El -frailer Court El Mot 1 ❑ Other ❑ •---------•- Number of living units: --J_.- Number of bedroom ___" Number of baths---- Lot size - �✓ �k- Water Supply: Public system ❑ Community system ElPriva#eADepth to Water Table -----__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamA Clay ❑ Adobe ❑ Hardpan ❑ Previous Application!Made: (If yes,date-------.-. ---------) No rt] New Construction: Ye�R, No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +anis or cesspool permitted if public sjwer is available within 200 feet. Septic Tank: Distance from nearest well-----3�.-_Distance from foundation---- a /_ Materials-`�pJ�._L ------ , No. of compartments.-_---____.- _ Size-- p� 1 _ _ �_,r --;- ----/I-0-_Liquid depth--------- Capacity----- Dispos I Field: Distance from nearest well.... ° --Distance from foundation- r -__-�_-__--__.Distance to nearest lot lie-___�`___"• Number of lines----------- ---------------Length of each line_---_". Ca_c3. ___--- Width of trench -" �j �� ' Type of Cfer material......... r Depth of filter material-.- Total length----- &al------------------------ Seepage Pit: Distance to nearest well----/_fTQ__ Distance from foundation-----/v-• ____.Distance to nearest lot line------ -__._ ----- Number of its-_-. -__-. .----_-Size: Diameter__.- - �� p �----•-- .Lining material-----�r �- --------Depth- ---' v2-� - r --------------- Distance Distance from nearest well-----------------Distance from foundation___.------.----.___.Lining material----_--"____----__---" .----_- _-. ❑ Size: Diameter- ---- - ----'-Depth---------------------------------------------------Liquid Capacity ' --------------------- --gals. . Privy: Distance from nearest well-.----------------------------------------------- from nearest b0din 9 Distance to nearest lot Gne__.--_.-_.--."_ _ _ Remodeling and/or repairing describe):----_ -----� -°Y C ------ --------r - -- - ----- -- --- ------------------- --------------------- ------------------------------- --------------------------- ----- --------- ------------- ------------------------------------- ------ --------- --------------------------------------------------------------------------------- q ----•-- ---------- ---------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and re lations of the San Joaquin Local Health District. (Signed)---------�` - �`�. -------- -----------�-�---- ------- ------------------ ------ -------- ----- - nd/Or C@n+rdCt@rli2 �.�.. - _ a --- - --------Title ice. -------------- y ____________ 4 (Plot plan, showing size of lot, a ' of sys+em in relation to wells, buildings, etc., can be placed on� rsess dei FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.------- - ------------ DATE------- "t l t- - -------- REVIEWED BY ---------- ' -- ----------------------------------- ------. DATE------- -'- --'-- '- '-- -------- ---�-- -'---- - BUILDING PERMIT ISSUED----------------- - - - • ------ y---- DATE---- - -- ---------'--------- --- -------- -'--------- - Alterations and/or recommendations:_ -J ` ----------- ----------------------"----.--- ------------------------ ------------ ...-.--- -'-------- -' --- ----- r - - ---'-' .-.-----. - ------------------------------------ -.- -- - n G' ` _---------"-------- FINAL INSPECTION B -. . / Date �— SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad!,California Manteca,California Tracy,California 4 � � F-.P,CO.