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FOR OFFICE USE: — I ----------------- -=----------------------------------- r ..__....__.____________________._.-.._____"--________._ APPLICATION FOR SANITATION PERMIT Permit No. ............. ------------------ - -- --------- ---------- ----------- (Complete in Duplicate) � T p 1 YDate Issued --- -G` --------- -- --------------- ----------------------- t This Permit Ex Tres Year From Date Issued 17 Application is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herei de b d. This application is made in complian with County Ordinance No. 549. JOB ADDRESS A DLO N!/o y _ -1.�- , ,a,p fist. ". °a2ct�i+ �z �f2 off -------_-___ #-- _-� Owners Name--------- ----- - - ---------- Phone---.-•------------------ - � Address--------------- - -- ------ -----i-�� 1-21 - - ---1-------• - i c Contractor's Name_--a,_,-. ' ---------------- Phone----------------------------------- Installation will serve: Residence �A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _F-_---lNumber of bedrooms _ Number f baths __1---_ Lot size ------------------ Water Supply: Public system ElCommunity system E] Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam El Clay [Adobe❑ Hardpan ❑ Ir Previous Application Made: (if yejdate...................1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P No. of com artmems_____ `.. Siztan�efro foundn___ NX� atioLQ_.r_____..Material �!-----------_-------. Se tic ank: Distance from nearest well---O------Di q P e/- -- - --'��r ----Li Liquid de th_#------------------CapacitYj;�na Disp Field: Distance from nearest well__. a"`_...Distance from foundstion----:f.d_fDistance to nearest lot lines------------- ; Number of lines ._____.__ ___"-__.._____Length of each line-___-?40_'________________Width of trerich...�7 Type of filter material---"_" i_ .t--.___Depth of filter material.-_ If._'---------Total length------IPA------__ See e Pit: Distanceto nearest well !,049 __..__Distance from foundation___._fa_--._-_.Distance to nearest lot line.4r___ ....__.._ P �s P --- '--------Lining material--------t3: .•-:_Size: Diameter------, "- --Deptn__..�'� -'---------------- Cesspool: --------------- Q Cess ool: Distance from IL________________Distance from fouridati __...._ _-"".Lining material__ ❑ Size: Diameter_nearest we-------------------Depth------------=--•-- -`------ Liquid,CapacitY ------------------gals. Privy: Distance from nearest well - ----- -____---."Distance from nearest building------------------------------------------ ------ ------ .. I. Distance to nearest 10+ line------------------ ---------------------------------------------_ ... --------------------------------- --------------- Remodeling and/or repairing (describe):................ .. ---------•---------••-----------------•---------------------- ------------------------------ f ----------------- -------- { K S __________________----------- -----_____________________________________________________________________________"__--_-_______----"_____-------__"_.-----"__-----__-__.-------------------------------------------- __"_____________. "____..__._.__..__._____ I hereby certif at I have prepared this application and that the-wwk-willTbe done in accordance with San Joaquin County ordinances, State aws, nd rules and r ulations of the San Joaquin Local Health District. (Signed)------------- --------- ------------- ------ - ------------------------------------ (QWmr.and/or Contractor) By: ----_----'---- -- -- -- ---- ----------------- -----------------------------------------(Title).--------- (Plot plan, showing size of lot, location of ystem i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY--- - L ------ DATE.---- -----!5;F� �`'�"`G'� BUILDING PERMIT ISSUED i REVIEWEDBY------------------------------------------- ----- DATE -----•- --------- ------------------- Alterations and/or recommendations---------- d,� --- __-_-. � - DATE--------- f ____.___--------- ----------�--- -----_--- "-- . -- ------------------------------------------ ---------------------------------------------------------------------------- ------ --------------------- -- r FINAL INSPECTION BY:... _---- /5 S Date--------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California p ., F.P.CO. 2