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FbR OFFICE USE;S ' APPLICATION FOR SANITATION PERMIT Permit No, ............. ....•-...............................•-- I .. ,...__._._...__-_-.,___......•__..•..__.•.... (Complete in Duplicate) Date Issued JP./Z .............. ..... This Permit Expires 1 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 described. This application is made in compliance with County Ordinance No. 549. U ; CC.5 -130 --10 JOB ADDRESS AND LOCATION-/ ----- Dk �.........._ ....- -^ — Phone.........:.............-•- ----•--- Owners Ne -- -------- ---• ---- ---- ------_..............-- ---••-•--••-- Address. ..... - -------=��•=�-- . . .-- ,.1 - 5 . --.............................: •----..__....---- Contractor's Name... .......... ... ' ......_.. Phone....._.. .. Installation will serve: Residence [g Apartment House ❑ /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .../.. Number of bedrooms _. /." Number of 4ths ..1.... Lot size ...... = f— _wr_% ...• -------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __--- . ft. C= Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay �obe❑ Hardpan ❑ Previous Application Made: (If yes,date-....... ...........) No ❑ New Construction: Yes ❑ No D FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept k: Disance from nearest well 5' Distance from�founai aa on__.. ------Material------ Q. . O �anNo. of compartments ySLiquid aeph. ------- Capacity.... � I /p Dispos Field: Distance from nea-est well 479....... Distance from foundat' Distance to nearest lot I�rlts�...... ._.... ,�j Numoer o= lines Length of each line.-......... _..Width of trench..._ce4. -................... Type o; filter materiol ..._. i.� ..-Depth of filter matcrial....._Iq�'.......?otaI length.. -�...._�- "--------------- I � r f Seepa Pit: Distance to nearest well._......j.4� _...Distance from foundation.__._�d._..__..Distance^to nearest lot lin�....... .___ .. • ...... Deptn._.L.`s................ ." Namber of p;ts. ..__�......-_Lining matenal._cs...� ..._._Size: Diameter. ._.._ Cesspool: Distance from nearest well---------...... Distance from foundation............ ...... Lining mater;a...................................... ❑ Size: Diameter..._........ .............. ......Depth ---••-- .......... ....Liquid Capacity ..._....._........... ga!s. Privy: Dis`ance from nearest well......... .............................. ........Distance frcm nearest building..........:-----._......_ ....---- ---- ❑ Dis4-ance to nearest lot line...............................•-------. . ............ ...._......._..-- ..----- --.. Remodeling ararl,', ..,.a.r nq (dcscr_.,�PI: [fid -G _ 4e_. - - l' '` ......... ............. ......•.........:T...........................•....-...........-----.......................................... 1 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: gulations of the San Joaquin Local-Health District. i d/or Contractor) I (Signed)-. __.4 . ...��... - -_ t - ----- -------------- ar.----'... . .errr �- g ►^-�- 'r... .. .. ... .. ... .. ... ..... ....... ..... ----._ .-- Y - . . t (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. . ------------- ------------_--•-- ------_--- DATE..L1_. � .t7 •-<; REVIEWEDBY--_----------"I ....... -•-•......................................................... "• DATE................... ' BUILDING PERMIT ISSUED.............................................. ............ DATE.....:::......... -: .. r Alterations and/or recommendations:...---•---•-•.._...... ..........._...."_....._..................----_........::...._. .: / .......................... +... 01 FINAL INSPECTION BY: .....-... Date.. 1,7 N SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfateltan Ave. 300 West Oak Street 124 Sycamore Street 203 West 9th Street 1 Lodi,Collfornia Monleco,California Tracy,California Stockton,California r.P.Ca.