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FOR OFFICE USE: - ¢---6-6-------------- ------ ---------------------------- v. APPLICATION FOR SANITATION PERMIT Permit No. . ._Q .. .?- --- ----------------- --------------- ------------- (Complete in Duplicate) Date Issued _----__----___-_- --------:...... i This Permit Expires I Year From Date Issued Application is hereby made to the San,Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..---_=5---6--�_R-----------€'-------H_P_A_A•T--------- -------------------------=5-r 1< ------------------- JOB --------------------- ---- -------- Phone------------------------------------ Owners Name-----�Y-N--�-------------- -�---H--1N-�---13 L_2-i4--------------------------• - - --------- -5 ------- _ Address_______. -------------------------------------- S r �' Phone r' f 4- Contractor's Name D----------- `5 ------------ -- . lT =1 1 i . F-�— - Installation.will serve: Residence jApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f----- Number of bedrooms .2--... Number of bath --- Lot size ------.1?0...---...... -- --��^---(------------ Water Supply: Public system Community system 7❑ Private M 1 Depth`to Water Table . k' ft. 1 Character of soil to a depth of 3 feet: Sand E], Gravel E] , Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J� Hardpan E) Previous Application Made: y If es,date---.-------1-------) No K—New-Construction: Yes No I-] FHA/VA: Yes ElNoX l � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is is available within 200 feet. Septic Tank: Distance from nearest well_ D.& -Distance from foundation-----LP-1-------M Y rial*XF_- �_-- �j No. of comportmems-------` _____________Size.. _K-.5 X--g-----,___Liquid depth----`F._z---------------Capacity.___ r p--- rr�- Disposal Field: Distance from nearest well-ll bNC---Distance from foundation----).0__t--.-----Distance to nearest lot line----- -- ------- 0^ �f ---------------------Length of each line--------- '�0----------.Width of trench----------- v` 4� Number of lin"es___.__�_= __ � t � , Type of filter materials' eC ____Depth of filter material----------I/S........Total length--------------------------- -------- Number of Its......... ............Lining materia. _,..I �Cf -Size: Diameter-___Distance t.. nearest lot line_____.. _... . V Seepage Pit: Distance to nearest well_��_�l_. .._. Distance from foundation______ _______ ___. ; �� 1 J p i3 = Depth 'S' Cesspool: Distance fram.nearest well-.-----------------Distance from foundation--------------------Lining material------------------------------------- F1 ----_--.-_----- ------------------❑ Size: Diameter-------- ------------------ ---------Depth--------------------- ------ ------- - ------------Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well.______-----------------------------------------Distance from nearest,building---------------------------------------- A Distance to nearest lot lire-------- ------------------ --- -------- - - --------------- ----------------------j -------------------- --------------------------- --------------- --------- 1.� -4 --------- S �-� ---------------- --------------------------•----------- ,.:. Remodeling and/or repairing (describe):__.._�--N��-�.-----, --.��-��- �``I-- -` - - _ °.. t --------------------------------------------------- ----------- ------------------------------------------------ A -------------- ---------------------------------- ----------------- ------------------------------------ - - _ --------- ---.-------_-----_-_:-r---- ..--------____----___-__-----_--_------.._-_---_-_-_--_-..-. . - . I hereby certify that I have prepared this application'-and-that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ► -t,,a, rti �►�sl - ---------------- (Owner and/or Contractor) Si ned _ -------------- --- ---------- +�1 , Title (Plot plan. showing size of lot, location of system in relation to wells,:buildings,,etc.; can be placed on reverse side). , E FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------ r --------------- "--------------------------------------------------- - DATE-------- ---------------------------- Ik - - ----- DATE------- ----- ----------• ---------•--------- REVIEWED BY------------- ---------------- ----------- ----- ---------------- ----- ---------- ----------- ------ - ------------- BUILDING PERMIT ISSUED----- - --------------------- DATE-------------------------------------------- -------------- --i i Alterations n /or recommendations:__-_. __ - - - ---- ----------------------------=-------------------------------------------- --- ------ FINAL INSPECTION BY::-_--^...( Z- -- --- Date �� i, .k SAN JOAQUIN`LOCAL-HEALTH.,DISTRICT 1601 E.Ha=ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Lodi,California Mantecar California Tracy,California Stockton,California 4 F.P.r_O. 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