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rUKUrrIC-k USh: --- -- - --- - --- --- .---___--._- .., APPLICATION FOR SANITATION PERMIT Permit No. - � ---- -------------------- --------------- -------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued Date Issued_A/y _� ` 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- 1 JOB ADDRESS AND LOCATION-.:___._-, 73_/_, ___-----_4':- Lt/�5_4-—_�`�� Owner's Name------ _�t_�.- $ j r t'�� AddressSTc._ .' .�_ --------------- - --------- -------------- Phone--- ---------------•------- -------------•--- 1 Contractor's Name---_._--- _ ---------; ' .f Phone-._Y- :`fr-5'l--! Installation will serve: Residence [t} Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other a Number of living units: -/--- Number of bedrooms --Z,___ Number of baths __L___ Lot size ----.- /_�- --�_-_ 1 ---- Water Supply: Publics stem { PP Y� y [�- Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 fait: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ Previous Application Made: (If yes,date----------.,_.-_._) No El- New Construction: Yes ❑ NFHA/VA: Yes ❑ No [c]— TYPE-OF INSTALLATION ANDSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r . �Se"p� ti6 T'Tank: Distance from nearest well---------- from foundation--------------------Material__-----_.__-.---__._.---_______-.____.-,___-._. No. of compartments--------------------------Size-----------------_ _ --------Liquid depth------ Capacity ✓ 1 .--.---...---Capacity ----•--- --------- Disposal Field: Distance from nearest well_jf4k_-._.Distance from foundation---/------------Distance to nearest lot line-S•'__.-- ®- Number of lines-'-------/-----------------------Length of each line Z -------------- Width trench-_- 2-TYpe of filter material---4 - - 1<----_ !- _Depth offiitermaterial �� _ ,--_-=otallength - W Seepage Pit: Distance to nearest well_-N�! _ Distance from foundation_---- -------Distance to nearest lot iine_s--------_- W [G]^ Number of pits---I---- ------------Lining material----- qac lC-Size: Diameter---__ 3"_..__--.Depth------�-r---_- ---------- Cesspool: bistarce from nearest well-----------------Distance from foundation------------._-_----Lining material--___.-._._-__-------_-------_In Size: Diameter--J-------------------------------Depth-------------- -------------------- ----.-Li Liquid Capacity - q -- ---------- -------- ----gals. s,PriJy:` Distance�_�e_are"_sf_lTt earest we -._-_ , -�;... = Distance from nearest,building.---_------ - -------------------_----- - �.Distance line-------------------------- ---------------------------------- ,-Remodeling and/or and/or repairing (describe) -•------------------- --------------------------------•--------------------------- ---------- -----------------------------'-------------------------------- «---- „� { ----------------------I--°-------- = = --------------------•----------------------------------------------------------- -----------------�--�------------------------~'-------------------------------------------------•------------------------`------------------------- Ilhereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State laws, and rules and; regulations of th� Joaquin Local Health 'District. (Signed)--------------------------- '.- - (Owner and/or Contractor) SY- ------------------ --- -- -_- -- ---------(Title)------- ----- -- -------------------- ------------ - ------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, 'etc., can, be placed on reverse side). R „} FOR DEPARTMENT USE APPLICATION ACCEPTED BY -------------------------------- ----- ------ DATE_ - -Z_3- �-6-S -------------------------------- REVIEWED BY-------- 1' ` k. ----------•------- ---- -------------------------------------------- DATE BUIL DING PERMIT ISSUED-------------•---- ------ DATE Alterations and/or recomm ndations -`-_---__-_••�.,., : _ . ----------------------------- ------------------- � --------------------------- ------------------ - --- -- ---------- ------ ------ ----f---------•-------" 4 ----------t- •-------•----------------- k FINAL INSPECTION BY: `------� ----�--� --- Date. - .h t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ay*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California, Tracy,California [ , L