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rvr[ l.lrrll,t U,)t: T .1 -------------------------------------- -� --------------- ----------------------------- -- --------- APPLICATION FOR SANITATION PERMIT Permit No ----- ---------- --------------------- --- --- ------ (Complete in Duplicate) "' ". . ..--" This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein described. This application is made in compliance with County Ordinance No. 549. /5 t�3 , JOB ADDRESS AND LOCATION__ —'F_t4$" ' Owner's Name ------ . Phone_ _ Address � f ----------0�[" . ;� Y-------------- Contractor's Name__________________ - -- -7- 5 4-7------ ---------- --------- S f Installation will serve: Residence x Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-./___ Number of bedrooms 4' Number of baths -1----- Lot size ---AQ._Zi : Water Supply: Public system y ❑ Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------- ------.._1 No 5�_ New Construction: Yes ❑ No Z�. FHA/VA: Yes ❑ Noj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation__"----------------- ❑ls1C[54-J44Material --------------------------------- �W(� No. of compartments-- -- -------------------Size------------------- ----------Liquid depth-- ------------------ ---Capacity------------- ....... �J Disposal Field: Distance from nearest we/7,5.-__Distance from foundation__" -.0______ � Distance to nearest lot line__Z�_�__ Number of lines----jf_ A!�--_CA __ --Length of each line__3A0-f------- " "__ Width of trench._��"1-".--__"" r Type of filter material___- - jt __ "-__-Depth of filter material------ - --------Total length-. J. Pit: Distance to nearest wefto-�_--------- ��^� Distance om undation_._..___________.. Distance to nearest lot line -�---- Number of pits_"(`IV __..__Lining material___ -.--Size: Diameter._..��_t_- -"--Depth----�.�"_-._-- .- Cesspool: Distance from nearest well________________ Distance from foundafiar---..._""_.____...__Lining material____.._________-__-_ ---.------------ ❑ Size: Diameter__. - Depth ------- -------------Liquid Capacity----------------------------- gals. Privy: Distance from nearest well------ "-__-.__-_-Distance from nearest building Distance to nearest lot line._____.---C,(4-- ----- - -- ------ " ------ ------------------------------------ f ---------- ------------------------------- - - Remodeling and/or repairing (describe):__-____ C -----"---- •-------------------- --------------------------------- (:::, -- --------------- I - - -- ------------------------------------------------------- ----------------------------------------- ---- ere ---- - - ---- --- ---------------------------------------------------------------------------------------------------------------------- I hereby certif repared this application and that the work will be done in accordance with San Joaquin County ordinan�, S e , s, and rules a d regulations of the San Joaquin Local Health District. (Signed _.___________"_______ __- -_ `- _ I ? (Owner and/or Contractor) By------------ -- ---- --- - 4 (Title )---- ng �buil'dings, { )---- (Plot plan, showing of lot, location of system in relation�io #c., can be place ort reverse side). 01FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_" � r° ,r `--_ DATE". _�. - (e REVIEWED BY---------- ------- - - - --- --- �. --------------------------------- BUILDING ------- ---------- --------- ---------------------- -- - DATE--.----------------- -------------------------------------- Alterations ----- BUILDING PERMIT ISSUED _ -- -------•------ ---- ----------- -------------------------------- -------- DA-TE----------------------------------------------------------------- terattons and/or recommendations:.______.___"_____---- ---- -----------------------------------•----- ------- - --------- -------------------------- FINAL INSPECTION BY: 111" e-------- SAN --------------------------------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1lasdton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California - Tracy, California