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r3K Uri{t W)t: f -- • - = ------- -- ---- ------ r , s 6 � APPLICATION FOR SANITATION PERMIT Permit No. _... ----------=----------- _..q..7.`5.__. 1. �� . (Complete in Duplicate) --- --- --- --- ------ This Permit Expires I Year From Date Issued Date Issued ---- _z Application is�hereby made to the San Joaquin Local Health District for a permit to construct and in Fall the work herein'described. This applicatioh is made in compliance with County Ordinance No. 549, t JOB ADDRESS AND CATI �J ---------- --------------------------------- Owner s --------- --Owner's Name-----------------` .f -- 1 _...._.... _ . Rhone Address--------- ------------------------------------- ----- .Y...__ --------------_-------- _._ ----._------------ . Contractor's Name--------------- h � `- ------------------------ Pone----------------------- Installation will:serve: Residence �`Apartment'House,❑,-.Commercial-�-[J=Trailer-Court ❑ Motel ❑ Other ❑ 11 Number,of living units: _/...___ Number of bedrooms _. Number of baths .�_- Lot size � � Water Supply:; Public system �Communit system y y ❑ Private ❑ Depth to Water Table ft. l Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Clay [❑ Adobe _] Hardpan E]Previous Application Made: (If yes,date- ._.____ } No New Construction: YesJ F�No ❑ FNA/VA: Yes ®— No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permit e,dI jf public sewer is available within 200 feet.) jl . Septic Tank: Distance from nearest weDistance �� om��foundafion....__-It!-rj..... Mater.__a-"� � No. of compartments..__..._ _.---�_�.�-51ze_ - _— —'ll _.Liquid depth_1.- , .Capacity-- Disposal Field: Distance from nearest well...___- ` Distance from foundatio ��__.. .Distance to neares 1Rgf line.- .. 1 "r- :... ` Number of lines------ ...__.. ength of each [in e_-__ ..____.._ i Width of trench._-.____ �] Type of filter material_ � ,� De th of filter material.._ ' _---Total len t!�-�� :_ ---___.----_ -v i r � f'q'I_ p 9 Seepage Pit; Distance to nearest weloov l _Linin --Distance fr � fou r�d5 z n---,/- `Dista c to nearest lot line.-. __--- Number of pits..--- material--- ----------Depth- Cesspool: De th- Cesspool: Distance from nearest well------- --.._.Distance from foundation__-_-.._ ----------Lining material..___--__..r------_____________ ❑ Size: Diameter----'-------- ----De th-------------------------- l---- -...-'r------- i i p - t -Liquid Capacity------------------------ ...gals, Privy: i Distance from nearest well......---------------- -----------------_--------Distance from nearest building- ❑ Distance to nearest lot line Remodeling an i/or repairing (describej: ....--_ ------------------------------------- ------ -------------- ------ ---- -----—---- yI ------- ---------- ---- - --'- hereb certif that I have - - - - Y Y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and'regulations of he San Joaquin Local Health District. (Signed)_ I i { ff - ----- --------------------------- r Contractor) By----------'ll'------------------------ - �----------- ---P'w�ells. -Crt- ---..... plan, shawi'ng size of lot, location of system in relati buildings, etc., can be placed on reverse side). -------- I�I - FOR-•DEP-ARTMENT-USE-ONLY--...r.. r. APPLICATION ACCEPTED BYi_-------- Gc-��- r- ---- -----u--------------------------- ----- DATE-------- REVIEWED BY--4-'-------------------------- - -------------- -------------------------------------------------------------------------- DATE----- BUILDING PERMIT ISSUED ------ ------------------------ ---------------�-�-- ------------------ ---------- ---------- _ DATE--------------- ---- ti ---------------- ---- =� Alterations and/or recommendations-------------- ---at ^`---------y— coli - y, c�� ^� - % 1 ------------------ f .. 1 ---------- -- ------------------------------------------------------ ---- FINAL INSPE(TI - ON BY:.____.'.�_r-...0 .0 _ ----- DatF2:50 ',- 7 11 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street �II .� 1,24"Sycamore Street 205 West 9th Street Stockton;'California Lodi,California Man eta,Caiifornia � Tracy,California