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-------------- --------- - -- - -- - 7 APPLICATION FOR SANITATION PERMIT' Permit No. � �® ' !M (Complete in Duplicate) Date Issued ........----"-- R�. This Permit Ex ire. I Year From Date Issued !��—47,�---,--------"__-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 49 d. I JOB ADDRESS AND LOCATION 1( ......... . _ Owner's Name-- t @ - ------------- Contractor's -------- - --------._. Phone_.------------------------- g - - ------------ Address__.__-, � ----••_-- r ------•- Contractor's Name___ .- � - p �..�a - --- -------•- 11 Installation will serve: Residence A artment House ❑ Commercial --------------- Phone__..______.___••--------------- ,�. ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _" Number of bedrooms _ _- Number of baths __/ .- Lot size ----��_ Water Supply: Public system r � ��f----- -- [ Community system ❑ Private ❑ Depth to Water Table -�IAft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: (:If yes,date.__-"_-- _ ❑ Adobe M---'Hardpan f] 1 No [/��New Consfiruction: Yes ❑ No E�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AIVD SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + ti nk:_ Distance from nearest well-..___________--Distance from foundation--------------------Material _____..__--_---______ 4 No. of cornpartments-------------------------Size s p -Liquid depth--------------------------Capacity 0Dis ams Disposal Field: �umbeeorom nearest-well f _____________________. -- "-.__.-_.Distance from foundation_" _. __-_--_-._" Qistance to nearest lot line_,-----__-__ i lines-------f--------- -- - --- ----Length of each line----�-;a--� .. ------- Width of trench----- �r� Type of filter material__s [ �('-Depth of filter material..../� _'�-----Total length___------------- Seepage Pit: Distance to nearest well �Qi_----Distant foundation____ _ / - k l__.Distance to nearest lot line��.s� ' Number of its._._-- _ y p -�------ material___ _ �� _ G.cf ` Size: Diameter-_.-�_.3_-_-------Depth- ---d�`'�----------------- Cesspool; Distance from nearest well_______________ Distance from foundation -------------_---___Lining material_.__--_...--_.___-_.__- ❑ Size: Qiameter--------------------------------------Depth-- ------- ---•-------- Privy: Distance fromLiquid Cc ----- ----------------------gals. nearest well._-�_" - - -------------Distance from nearest buildin nearest lot line g ------------------------------------- -- -------------------------------------------------- as ante of Remodeling and/or repairing fdescribe):-----_-.---__------------- --------------- ---••----------------------------------- -------------------------- ------------------------ ----------------- ----- - •------------ ---------------- -----------•-----------------------------------------------•--------------------------------------------------- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statws, and rules and gulati s of the San Joaq in Local Health District. (Signed)-------------------- ------------------ (O w er and/or Contractor) gY� , ---------- .. - - _ (Title]... -- .l! (Plot plan, showing size of lot, location of system in re ation to welts, buildings, etc., can be 1 e� iP p ed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY-ll-__- ------------------------------------------------ ------ DATE `z REVIEWED BY--- -- ----- -------- ----'`--- --- --- -------- - - - BUILDING PERMIT ISSUED I`---- --------------------- ------------------------------------------------ DATE-----------------.--•--- Alterations and/or recommendations:_--.- ATE______________ ---------- i-------------- ------- -----------------------i ------ -- -- ----- ------ - --------------------------- - - ----------- FINAL INSPECTION BY:...- ...00 .--_ `o Date--------3 " �/- II SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 91h Street % stockton,California Lodi,California Manteca,California Tracy,California K,P.CO. y