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r ------ ----- , E -------------------- ! a,- z i APPLICAfiON R SANITATION PERMIT ---- -- (Cernplefe in Duplicate) S= ------ This Permit Ex fires 1 Year From Date Issued Date Issued __-- ` S� Application Is hereby made to the San Joaquin Loca! Healfh District for a per to construct and install the work herein described. This application.isimlade in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-, t-0 L ft 7 Av a /p ` - -------------------- Owner's ------- �I------ E Owner s Name------------------��-�' � --------- d L��„Address--=----- r = 7�-_ ' C7 Phone one '� = o- :- t-1c nI ------ Contractor's Name_--._----,Qt±V_!l�� _ . Installation will serve• Residence 'Apartment House Comm Z-- Phone----------------------------------- ❑ P ❑ ercial ❑ , Trailer Ger# ©Motel ❑ Other �- Number of living units: j----- Number of bedrooms _z-Number of baths, .... Lot size _-�-��,-I`}��- Water Supply: Public system E] Communit system stem Y ❑ Private Depth to Water Table Lift. Character of soil to-a depth of 3 feet: Sand Gravel ❑ Sandy-Loam ❑ Clay-Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: '(If yes,date----------------- -) No `Now Construction: Yeso' N TYPE OF INSTALLATION AND SPECIFICATIONS:. ❑ FHA/VA: Yes ❑ No " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic�Tn ance from nearest well--_ _-.. Distance from foundation____!_`0-.-"�-Mater'al-� _?J�fC _T Disposal Field No. of compartments-.. .---_ 2--- ---- Size `f� ��( 6--- _-Liquid depth --.-75 �5 �� --- Ca acif �`Q�. p Distance from nearest well.-.J _.-----Distance from foundation--_-f0.---------Distance to nearest lot line---- _-__•'� f L Number of lines------- -------------------------Length of each line-------7 ----- ,. :� Width of trenchj�� f --------= Type of filter material_-AO Depth of filter material-----/_ g -------_----- Distance to nearest !of fine-------------- ------Total len th------- ----70----------•------- Seepage it: Distance to nearest well-----------_---------Distance from foundation----- ❑ Number of pits-------------------_-Lining material._-.- Size: Diameter------------------------ Depth --- -- --- ----- -- = 4 Cesspool; Distance from nearest well-----------------Distance from foundation ...-. -----------Lining material--------_ 7� ------------ Privy: ---- G. ❑ Size: Diameter------- ---------- ---- ---- -----Depth�------ ---------------------- -----------------Liquid Capacity---------------------------- �._ gals• Privy: Distance from nearest wefl--._------ ----------- - -------------Distance from nearest building __ _ ❑ Distance to nearest lot lire - ------------------ Remodeling and/or repairing (describe)----------------------•---------- _ (� " -------------------------- --•-------------•------------------------------•----------------•-------------------------- ------ -----------=----- --------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance wif ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. hSan Joaquin County (Signed)------ -rL� � Gc _—.t------------------------------------------------ -- - - ----------------- --------------------------------- ---------------------•----------------- (Owner and/or Contractor) $Y:. ---- ---------------------------- ------- --- - - ---- --- m •,.z �. _ _. Y (Title) (Plot plan, showingz�e of lot,'locafion of s stem in relation-fo wells, buildings, etc., can be placed on reverse side).. 4 z t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------i---+-_J'�}_._0--------------------------- - DATE -�- ��--`--�--' REVIEWED BY---•------ ----------- - - ----- --------------- DATE--------------- ----- - UILDING PERMIT ISSUED---•--------------------- - - ---------------•----------- ------------- �------ - ----------- DATE------- Alterations and/or recommendations:-_----.---- ----- -------•------------ ------------------------------------- -------------------------------------- °` - --------------- -------- ------------------------- ------------------ -- FINAL INSPECTION BY:....-�� - Date------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave- 369 Wes!Oak 5treeF U ,r. y02'4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California l Manteca, California , �,� Tracy,California iMMr -.