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ivrcvrrl�-t u0t: -------------------------- ---------------- WA �� OL 41a �6 ___-____ APPLICATION FOR SANITATION PERMIT Permit No. • ,D - --------------------------------------------------------- (Complete in Duplicate) --- -------------` ----------------- - This Permit Ex ires 7 Year From )ate Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei d scrib-- . This application is made in compliance with County Ordinance No. 549. Q JOS ADDRESS AND LOCATION_ � ov - ' _- � Owner's Name-- �/�r �, . ' _ -- Phone i ---------------- Address__. L - - - --� -------?&�w Contractor's ame_.- -- --- --------------------------- Phone-------•--•---------•-•-•--------.. Installation will serve: Residence 8[Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -/__-- Number of bedrooms a_- Number of baths �__- Lot size *� ❑ -. . Water Supply: Public system E] Community system E] Private � Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,dote------------.-------) No R�— New Construction: Yes 99"No p FHA/VA: Yes 9�--^No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wall-�------Distan e from foundation- C No. of compartments--. ----------- -- -----------------Size- ---�,�►��re1C+�r�1 Li uid de th -- ` O q p Capacity.fl !------ Disposal Fieid: Distance from neared{ well. .---Distance from foundation__ -- ----.-_._.Distance to nearest lot line_101 �_____.__�4{/� Number of lines_-_._ --- - ength of each line_ 'f��------------Width of trench__�____--•------- Type of filter material_ _- ----------- �� epth of filter material____��__----__Total length_- p '`------------__'-- Seepage Pit: Distance to nearest well.-,,o` 09*' Distance fu;m foundation-- __ ------Distance to nearest lot ii�e...�y �® Number of pi#s.._A----------- _Lining material__ - -„P___S�ze: Diameter_ �- Deptha2 -------------------- Cesspool: Distance from nearest well________________ Distance from foundation------------.-------Lining material----_-_..__._-_.___._ 4 - ---------------- ❑ Size: Diameter------------------------- ------------Depth-------------------------------------- -- --------- Liquid Capacity------------------ 1 3 ---------gals. Privy: Distance from nearest well-------------_----- -----_--------Distance from nearest building Distance to nearest lot line-.____._-__-_ _. Remodeling and/or repairing [describe):'__.._.__-- 1 V- ----------------•----------------------------------------------------- - ---------------------- ---- ------- ----- ---------------------------------------•------------•------------------------------------------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned �'� { g } --- ----- -- -- - - -- --- ------ • ------ - or Contractor) (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on rev e) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ l. DATE / - �° REVIEWEDBY------ -------------------------------------- -- / -------------------- ---------- DAT. ... - - --- BUILDING PERMIT ISSUED-------------------------------------------- --- ------------------------------------------ ---------------- DANE. ------------------ --------------------- Aterations and/or recommendations:__.___________________ -_-- --------- - --- - -------- ---------------------------------------- ---- ---- FINAL INSPECTION Byv.14 ,�s ---------- --------- Date__.- - - _.-.�f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, Californip F.P. G.