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- ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. l � _ - — ----------------------- ------------- -------- (Complete in Duplicate) ----- ----------------- Date-- --- This Permit Ex fres 1 Year From DtIssued : - Date issued �-�_a-�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A LOCATION.... 4_-7_ ---------- � �, Owner's Name-"_ ► ---- - --- Z-- ------ Address ° ®�} ----------------- ----------------------------------------- INPhone ----------------------------------------------------------------------------------- Contractor's Name----------- ._�� � ----- ---- -------------------- --------------- Phone E, Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El, Number of living units: __l_ Number of bedrooms —7- Number of baths --I,- Lot size Z.��"ill-�.�_� _ Water Supply: Public system ❑ Community system ❑ Private 2L3-15'epth to Water Table 40*aff Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑�� Clay Loam ❑ Clay ❑ Adobe ®—iliardpan ❑ Previous Application Made: (If yes,date______ ________ _ ) No [ New Construction: Yes © No. ❑ FHA/VA: Yes 9 —No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public Sewer is available within 200 feet.) Septic Tank: Distance from nearest well- pistanc�e from fpunclation__ ___ ` ��--__-..Material. - __ r �� No. of compartments__ ---------- - -- ------- -- ---------- Sizet'ZGiquid depth---�--. _ _ Capacrty Q------ Disposal Reid: Distance from nearest well-_-7147�-Distance from foundation,�,i _ ......Distance to nearest lot line. �_-•_- Q� Number of lines----,,___".___ Length of each line-- ` ' i �--- -- --- -- g - ---- -«------.Width of trench-4'of filter material_�-4.��_Depth of filter material-- --Total lengthv�_t .- Seepage Pit: Distance to nearest welt- --� Distance from foundation_ ----Distance to nearest lot line.rxl__-__•__--_ Number of pits.__----_------Lining material--_474A * ' __S ze: Diameter_ �---_------Deptn_iL,!`� r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------- EJ - Size: Diameter-------------------------- -----------Depth--------------------------- --- Liquid Capacity ------------------------- QPrivy: Distance from nearest well --------------------------gals. -___-___"Distance from nearest building------------- -------------------- --- ----------------------' ------------------- ---------- ------------------ -------- Remodeling and/or repairing fdescribe _________________ � I SF _ - j - --------- -------------------------------------------- ----------- / -;k =- Y Y P p Pp i —�------- ------- ---------------- acCordatice wi+h San Joaquin County I hereb certif that I have re ared this a lication and that the wor will be done in ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. r (Signed)------------------ o ---------- ----- ----------------- - ----------------------- BY:----------------------- -•-- - -- • - -�� d or Contractor) ------ -- •---•--------- ---------- -- --------------------------------Title_ (Os#/ (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can beplaced an reverse side). FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY___"-- - --------- -- t __ _ DATE- ---------------------------------- ATE- REVIEWED BY--------------------------- ----- �--- --- -- -------- ----- --- - - ------------- —�'' BUILDING PERMIT ISSUED --------- ------------------------------------------------ DATE G,� D 'TE-. ------------ ------------........................ Alterations and/or rec rrwenda+ions:�- _ � - lt�� ------------------------ ------------- --------------- ______________________ _.t__ moi'.. FINAL INSPECTION BY--------- - ---- -- ., Date �_ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street A '''� i` Stockton,California F.P.Cq. Lodi,California 205 West 9rl�Street � Manteca,California Tiiticy,California }�