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rVKvrrik_t uot: -4-549--k-5-------------- ------3 -- -- ------------ ---------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. . a- f ------------ -------------- -- -------------------------- (Complete in Duplicate) ------------- ------ This Permit Ex fres 1 Year From Date Issued 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. JOS ADDRESS AND CATION-_,��?owi�_-- -------A 1— -------��Zfooe_)V44.----- ---- --J&41401� Owner's Name---- L1 ---------------------- Phone --------------------------------------------- Address. . Contractor's Name.-•---------- � Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial E] /Trailer GOOr1- Motel ❑ Other ❑ Number of living units: __/-- Number of bedrooms ;Z- Number of baths /-.. Lot size _42� _O_ --_-:- = -Water ---------------------- Supply: Public system ❑ Community system ❑ Private R ]epth to Water Table /X ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam PT`�Clayr❑" Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--..--_.---.__..-_.) No U?` New Construction: Yes �o ❑ AFI-IA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.)41 Septic Tank: Distance from nearest well--� _-__Distance from found ion- ®� No. of compartments---02------------------Size -----X ?+rl_iquid depth_-- -.- Ca acit ` Disposal Field: Distance from nearestwell. -____-Distance from foundation. s9 � f "j .--------'Distance to nearest lot line/J- ----- Number of lines----_�----__ Length of each line_ �_---------'-_Width of trenchA__,a-___ ,� /, g f� 01 Type of filter materia_ __------Depth of filter material__ ----_Total length-�� Seepage Pit: Distance to nearest well----------------------Distance from foundation-------:__----------Distance to nearest lot line.--_--.----_-___ ❑ Number of pits------------------- Lining material----------------------Size: Diameter- --------------------.Depth------------------------- Cesspool: Distance from nearest well-------------___Distance from founclation_ -------------_-_Lining material------_.---_-.__-------.__ r ---------- Size: Diameter--------------------------------------Depth----------------------------- - ------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-----------_----------------------- ------- from nearest building ❑ Distance to nearest lot line-------------------------------------------------t ----- - Remodeling and/or repairing (describe):--------Gp�/ � , `� G -------------------------- ----- ' - r ------ --- ----------------- -- �-- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County N'Ordinances. State laws, and rules an regulations of th San Joaquin Local Health District. igned)-------------------------- BY:----------------•--------•------------------••------------------------------- � °r Contractor) ) (Title) ------ - ----- --------or- rr(Plot plan, showing size of lot, location of system in relat° o wells, buildings, etc., can be placed on reverse side). + i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -------------------- -- -- -------------------------------------- DATE- lL° LT--'.-�P3?-------------------------- - - --- - - - - REVIEWEDBY----------------------------------------- ----------- ------------------------------------------------------------- - DATE ---------------- UILDlNG PERMIT ISSUED ------------------- -------------------- ------------ DATE------- ------------------- -------------------------------- aerations and/or recommendations------------------ - -------------------- ----------------- ------------------------------------- ----------------- --------------------------------------------- --------------------------------- -----------------------•---•--- --- -- FINAL INSPECTION j BY:. - v � Date--- _ D _ .r - - ------------------ - SAN-JOAQUIN LOCAL HEALTH DISTRICT rr + 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,l California Lodi,California MTracy,California- � _ R nt�eca+California •