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rvR l.irril_r USt: — ------------------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ODY (Complete in Duplicate) --- -- ------------ --- ----- --- This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Hsalfh District for a permit to construct an i. he work herein described. This application is made in compliance with County Ordinance No. 549. 2. Ut 0 e E. . JOB ADDRESS AND LOCATION / f Owner's Name---- /r� Ps Address------------- e =.. Contractor's Name_______ 14- ------ -----------------------•- -------- - -- --------------- Phone...... 04 Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -,/-- Number of bedrooms -.S- Number of baths d`__ Lot size ❑ --.C•-___••____••__-__•______•__-- Water Supply: Public system ❑ Community system s ❑ Private �epth to Water Table Character of soil to a depth of 3 feet Sand p Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No VTNew Construction: Yes ❑ No ® FHA/VA: Yes Z4-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ( ' � II Septic Taek:. - Distance from nearest weli-----------------Distance from foundation___________________.Material________.__------------------------------------- ,0" � 'No: of compartments__. Size ------Liquid depth--- - Capacity----------------------- � Disposal Field:— Distance from nea ' st well..��-�--Distance from foundation__�Vf- ___Distance to nearest it line-��------ Number of line:0 _ _._ _ g e f:�--/Width of trench--.. �kl /� Length of lin -- f $eepa e Pit: Type of filter material/ �i -_De th of filter per, 1 '�-�`�__ ..--Depth ----------------------------- Seepage 7------- -- q Distance to nearest well------_---------------Distance from foundation___________..._____. Distance to nearest lot line____._______.._. ❑ Number of pits. ----------------Lining material---------- -----------.Size: Diameter--------- -- ----Depth----- ----- --------------- Cesspool: Distance from nearest well-----------------Distance from foundation.._._._.__---_____..Lining material__---.___________.__.______- ❑ Size: Diameter--------i__..__-__--- ------ ---Depfih----------------------------------- ---- ----- Li uid Ca acit �.� _ , q P Yom_= gals. Disfiance from nearest well -__ -_ -_- _Nstan e�from nearest b0clin -- ------ ------ ❑ Distance to nearest lot line-----_----___------------------------------------__ _______________ �______...__-- -----------I _ Remodeling and/or repairing (describe) ... ------- _� ,` Q � a+T - -- ------------------------- ------------------------------------------------------- - - ------------------------------------------------------------- - -------------------------------------------------•-- -------------------------------------------=----------------=----------------------------- ---------------------------------------------------------------------- -------------------------- --------------- I hereby certify that I have prepared this application and that +he 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 Contractor) --------------By:---------------------------------------- •-- Title /o g Py (Plot plan, showing size of lot, location of system in relation t. ells, buildings. etc., can be laced on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY______________+_ - -. ----------- ------------ DATE EVIEWEDBY--- -------------------------------- ---- =- ----- ------------------------------- - -- - ------- DATE--------------------•- - - ------------------------- -- DING PERMIT ISSUED ------ -------------- ------ DATE - - --------------------------------------------- --------------------------------------- terations and/or recommendations::_..-`_.___._..____ . -•---------------- ---------- ------------------------ -------- = - ----- - "F ----� _ ------ --------- - �------ - --- - -- -------- IAECTION- 8... Y______________ _ _ �--�+ .r ------ - ------ D +e a SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California a F.Rr O.