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rvrc vrrrt,t USk: t: � __ - =�6 ------- -- ---- ------ APPLICATI ONCom lets in Duplicate) SANITATION PERMIT Permit No. ......... """"" This Permit Ex fres I Year From Date Issued Date Issued Application is her made to the San Joaquin Local Health District for permit to construct and install the work herein described. I I ' This application is made in compliance with County Ordinance No. 544. _ JOB ADDRESS AND LOCATION..___ 7 -- - Owner's Nam _ ----• - e "---------"- "-• - -------------------------------- Phone_ Address ------------ ------ : Contractor's Name_________________ _ -------_----------------- --- --- Phone Installation will serve: Residence nn Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �r A. Number of living units:;___ Number of bedrooms _�-__ Number of baths Lot size ------- _" --- ----/-•Z5-------------------- Water Supply: Public system',,[2Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ If {yes date____---------------J No XNew Construction: Yes �No ElFHA/VA: Yes El No E]Previous Application Made: II TYPE{OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted•if public sewer is available w thin 200 feet.) i Septic Tank: Distance #room nearest well--- Distance from foundation-----�.�""- Material----- /P__ qa No. of compartments_._-__" I-_ -------------Size------ - x"" _"Liquid de th_ q P. Capacity -- Disposal Feld: Distance frlom nearest well-..._-" '__.._Distance from foundation.__ !7""".-_ ❑/ _-12 -Distance to nearest lot line.___1_�___.. Number of lines_____ _'_ --_--`------------- Length of each line----------f'--T1-----1--__Width of trench----------T e of filter material--____ _ f- '/ ;;,— Type Depth of filter material____.___�d't" "Total length_-_____.-_- -------------------------- Distance � I r SeepagePit: Distance to nearest well-__._____ � --------------- / _.____Distance from f undation-------` UE}istance to nearest lot line_-___l._J Number of!,pits------".__�..-__"--Lining material_ _..Size: Diameter. -?�� Deptn.- --------------- ' f Cesspool: Distance fi;om nearest well-----------------Distance from foundation_"______-_________.Lining material--- ---------------------------------- El ' Size: Diameter Depth -------------------- ----- -------` ---Liquid Capacity- -------gals. ----------------------Distance f ' Privy: , Distance from nearest well � g � I from nearest building t ----------- Distance to"nearest lot line---------------""---_ I. ----- Remodeling and/or repairing (describe)---------------------- r ------------------------•--- ------------ ------------------------------------------------- ----------------------- ------------ r i ------------ --re ti ---------------------I --------------------------------------------- G - ----------------------------------------------------- 0 Y hereby certify that I have prepared this application and that the.work.will,.berdone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.,+i •� (Signed)---------- ----------•- I I By; � r (Owner and/or Contractor) - (Plot Ian; owing si of lot location of.s stem in refs+ion to wells,. (Title) w P r ( )-------------------------------- ------- g Y buildings, etc., can be placed on reverse side). k F { FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_� --------------------------- L/S ---- ---- DATE REVIEWED BY ----- ------- ------------------ ----I------- ---- DATE BUILDING PERMIT ISSUED----------- - - DA•T. IZ Alterations and/or recommends#ions: f � -- -""--`----- -•i ----------•----------•------ ---------------------------- - , ------------------------------------------------ ----------------- -----"------ ------------------------------------- f--------I------- FINAL INSPECTION BY:.... f - ----------------------------------- Date � �'� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 6.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California ">.s.�,.ES 9_FEEWSED"8-59-3M_3-'63 F.P.CC.' v+.v