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ruK urrll,r VJt: ----_-- ----------------------------- --- -------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ---------------- ------------ (Complete in Duplicate ------...--- This Permit Expires 1 Year From Date Issued Date Issued !_-L&.__: 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. JOB ADDRESS AND LOCATIO - - f zlo �z� Owner's Name t '�!1/ �s .--• Phone. r� D� ------------ Address----- / ---J----"`--- -------------- -------- -- Contractor's Name ------- Installation will will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Cwt M- Motel ❑ Other ❑ Number of living units: __ . Number of bedrooms _a-2_ Number of baths __,l___ Lot size ------ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _Y__� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes M-"No ❑ FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION A-ND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (J _/ + Septic T nk: Distance from nearest well_ L`_._ _Disfance from foundation-/ -0 ---- Material_ �1Qi.-___ ----------------------------- --- [ No. of compartments____ y/ --------------Size______szt,XS Li Liquid de th____- t �`� q P. �- ----- ------ - Capacity--��o�'��-�- Disposal :eld: Distance from nearest weII•SL`-___--..-Distance from foundation__c�1.e___. Distance to nearest lot line_s5'___24-!/- Number of iines_ .jZ Length of each hne__l_�__43_'�-�Q_�_.Width of trench._ - -r�--------------- Type of filter maferiaI___T� " ' -��'--Depth of filter material--- length-_/0-6 Seepage Pit: Distance to nearest welIA0.4_'-'4----Distanceom foundation___: __-___.Distance to nearest lot line-;5:------ L ' Number of pits_._.__-----------Lining material__r_ _pe ___._.Size: Diameter__ 1 - --- Depth..... -, --- ------------- - Cesspool: Distance from nearest well-----------------Distance from foundation__-._.- --.__..Lining material_.._----______________.___-____. El Size: Diameter- ------------------------ -------Depth-------------------------------- - -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________________________ ___._.__Distance from nearest building------._._-------------------- Distance to nearest lot fine-----------------------------------------------------------------_ Remodeling and/or repairing Idescribe)------------------------------------ ----- - ------•---------.------_ --------------------------------------------------•---------------------------------------------------------------------------------------------------------- ------------------------------ ------------- -Y I hereby.certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules 7.d regulations a the San Joaquin Local Health District. G e ` - Contractor) (Signed)-------- ----- - -- ----- ----------------- ------1'�-e-�r --------------------- ---------------------- �l�r and/or Cat t Own or) By:----------------------------------- - _. (Tifle)'L v ------------ ..........._ (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY REVIEWEDBY----------------------------------------- --------------------------- -------------------------------------------------------- DATE -- ---------------------------- UILDING PERMIT ISSUED-------------- ------------------------------------------------------------------------------- ----- DATE--------------------------- - Alterations and/or recommendations-------------------__-------------------------- ------------- ------------------------------------------------------- ---------- ------------------------------------------------ -------------------------------------------•----------- � �1 -------------------- 2 •� FINAL INSPECTION BY: Date_.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.00.