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FOR OFFICE USE: ry,. r APPLICATION FOR SANITATION PERMIT Permit No. cr�...- 03 --------------------------------------------------------- ------ -- ---- -- ------- --- -- ------------------- (Complete -- ---------- Comete in Duplicate) From Date Issued Date Issued This"�Permtf`fxpires .1 Year Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This.application ris made 4A compliance with CountyJOfdinance No. 549. �, t I JOB ADDRESS TAND LOCATION - ---- ] ..--� ?- _-- ---�.---�:1-- 1-- - 1--� :-.---DCo/-- I fad ZZ Owner's Name _/ - , -L" =------ r Address k —/� 1 L ----------- ==---------------------------- --------�- '- �- - Q _' '� 1 A Contractor's Name_- Zf— Via .► &/ - - �1� 1 -- .1 f Phone" c�1 1 Inst Ilation,w.ill,serve: Residence Apartment House Commercial'" Trailer' Court Motel'❑ Other. l", Number of living units __.. _-_ Number of bedrooms _"' Number'of,bath�s Water Su I Public s stem Community system Private De th to Water Table � �"""' '"�" PP Y• Y ❑ Y Y ❑ P t A Character of soil+o a depth of 3 feet: Sand ❑ Gravel ❑ "Sandy Loam ❑ 1CIaytLoa `❑ Glay ❑ Adobe Hardpan ❑ Previous Application Made: [If yes,date____________________) No ❑ New�Co>nfiructon: Yes ❑ No ❑ FH,AfVA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " '�{Not-septic,tank;or cesspool-permitted.if public sew oris vatlable wlthiitz20D fee+.] —_ a Septic yank:� �Dot of compartmentsance from t__well_______-_ _____:Distancee��fpm fob d#tli*iqu�d d--- ----Material- - --- ------------------------- --- ------ e th--------------- - �_ Capacity ^} P ry p P Y 41 £ E ❑ L_,Div 1<�-� � - Disposal Field: Distance from nearest well...._- Distance from fn dafion_____ (____.Distance to nearest lot line_ T eAof fil.terrmaterial__-�-�� De gh of_filten..material-_--._1_.6-1_-�--Total len t�h_1 -------------------- i '/ } m Numb er of lines_________________________.._______Len Length of each line__________�_�_,f�__Width of tre.lih______ 5. �_ °� -----_--_�___--__-_ Seepage Pit: Distance o nearest well----l�:�'_.__Distance from foundation____�!�'Distan�re oq�r'es;lot line-- - -° -- Num6e�34pits ____________Linin material__ .��5ize: Diameter_.___ � f s P 9 z D4ptn �,� Cesspool: Distance fi m nearest well_________________Distance from foundation.__._..___..___._...Lining material-_-----._.._-_.____.__.____________. Size 'lameter----------------- --------------------De th------..--------------------------------------------Li uid Ca aciit ❑ Pq P Y ] 9als. Privy: Dist nce f�m nearest well----------------------------------_--------------Distance from nearest building_ _ __.______ ' El Distance to nearest lot line-----.-_____._._--___ _ _ sRemodelin and/or re 'in describe): - --_-_- r z c - ---------------------------------------------------------------------------------------------- ----------------------- --. - I hereby certify that I have prepared�this 9application and that the work will be done in accordance�wi+h,San-Joaquin,.Coun+y ordinances,•State-laws, and rtiiesrand.reguletlonssofAt San Jos'quin Local'Hea1+h.D`istrict. '" 1 r. (Signed)______:------- :�r-��-�� ' 1� �;1 ,____ - _ -[Owner and/or.Contractor) -- - -------R ----------------------------------------- (Plot - ------_- -------- ---- [Plot plan, showing size Tat, lot on of Sys tem In relation ffi wefls6uildings; etc., can'> eplacedjon revehserside} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -4. 4 DATED' REVIEWEDBY------ ----------------------------------------------------------------------------------------------------------------------- DATE--------- -------•- ------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ -------------------- --------- Alterations and/or recommendations:--- --------------------------------------------------------- -----------------------•----------------------------------------------- ------------------•-------------------------------•---------•----•--------------------------------------------------------------- ----------•-----------•--•--------------------------------•------------------------------- --------------------------------------------------------------- -------- - - ---------------------------- --------------------------------------------------------------------------- - ----------- ------------------------- ' -------------------------------------------------------- ----------------------------------------------------------------------------- -- ---------- -------------------------- -----------•------------------------------- -------------------------•--------------------------- ----•----- ---------------- ---------------------------------------------------- FINAL INSPECTION BY: -.. � ------------- Date.... ------------------------------------------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1