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K ul-l-1 k USE: 3 } 1 --------------------:------ ------ -------- APPLICATION FOR SANITATION PERMIT Permit No. ...�.�?..-. - ------------------- ----------------- 6aete} --------------- (Complete in Du Date Issued Duplicate) ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr6ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.--J'!----" ---------- --- ____-----.- _ -- ------------------ -- ----------•-------Phone------------------------------------ AddressOwner's Name---- r..._ -------- :=A-eZ0q1 Contractor's Name-_-_.-- -------.--- Phone....- ----_______- Installation will serve: Residence 9' Apartmenf House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _./___ Number of bedrooms .. ..... Number of baths .1-. Lot size .,l15, --�' -------------------------- Water ___________________ _Water Supply: Publics stem pp y: �y ❑ Community system ❑ Private [+�'�epth to Water Table Character of soil to-a de th of 3 feet: Sand Gravel Sand Loam Clay Loam r P� ❑ ❑ Y ❑ y ❑, Clay [3Adobe 91"Aardpan ❑ Previous Application Made: (If yes,date_ _ ----- --------- ) No PT'- New Construction: Yes �No E] FHA/VA: Yes ❑ No �- TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank o_ r 'cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearest well...-Q..-=Distance fram foundat•on:.._A�.-.--_-.Mate�iaL. E , - ------------- r No.,,of compartments----- ---- --- ----- sill_-,?,-11 -Y-,�q_`--Liquid depth-----�----- _ ---. capacity ------------ Disposal Field: Distance from nearest well__.. ^ Distance from foundation._---------.-..Distance to nearestllot Iine'--!/Nu ------ b'r of�lines�ti..�,.....----------- -Length of each line--� .. - -__--.Width ofgfren� -�- ----"�1�----------- Type of filter:materiai.,�e_--Ff _De th of filter materaf...-. -----------Total len th_ _________ _---------------- Seepage ________ P 9 i 1 ' ,p.�� 9-�-� - - -------.Size: Diameter-_- Distance to nearest lot line--. S See a e Pit: Distancerto-.nearest well----- ---------- Distance from foundation.-_------___._--. ❑ Number"6f its------------- - ------Linin materia(---- ------ --------Depth---- - --------------------------� Cesspool: Distance from nearest well-----------------Distance from foundation-------.--------- ..Lining material---.-__-..._...___------.__--------..00 ❑ Size: Diameter- - -------------- ---- - -------Depth--------------- ----------------Liquid Capacity----------------- ----------gals Privy: Distance from nearest well--------------------------_.---------- . ..Distance from nearest building_.-.- ----------------------------------- 4S El Distance to nearest lot line-- --- --------------------------- ---------- ----------------- I // 1 ' Remodeling and/or repairing (describe):-------- - ��l- _- . - � -----•-------------------------------------- 1 - ... ----------------------------- - -------------- ----------- ----------------------- r ------------------------------------------------------------ ------------ r t 1 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. (Signed). - r _ "--- -- ----------------------------- -------(�r'Confractorlr� By:---------------------------------------------. --------------------------- -------�/d -Et r + �---- -- ------{Title)--- -------------- --'-- ------ ------- (Plot plan, showing size of lot, location of system in rel:a on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCs PTEDBY DATE----- �,5~ �--------------------------------REVIEWED BY------ --- - ------------------- ----------------------- .------------------------ - ------- ------------- -- DATE----------- - ------------ -- --- - - ---- ---------- BUILDING PERMIT ISSUED-------------- --------------------------- -- - ------ DATE ------------ Alterations and/or recommendations:------------------ --------____---.-.----- ----------------------------------------- --------------------------- ------------- -------------------- ----------------------I--------- ----------- '--------------------- ---------------------------•------- ------------ ------- ------ -- ---------------- ---------- ----------- - ----------------- ----------- -------------------------------- Y 4 FINAL INSPECTION BY- - - -------------------- -------- --------- - Date------.. ------------------------------------- 1Z;'- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 114 SycanroT Street 205 West Stir Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r-C1.