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......... APPLICATION FOR SANITATION PERMIT Permit No. ...... .... ......... (Complete in Duplicate) Date Issued 246../`�< ---------- ------------------ This Permit Expires I Year From Date Issued Application is hereby made to the San;jJoaquin Local Hea[+h District for a permit to construct and install the work herein described. This application is made in compliance ;with County Ordinance No. 549. Z JOB ADDRESS AND LOCATION ... B& 41IC:. ....................... .... or Z Owner's Name------... ._'A — 6 � ii-__ -------- ...... ------------ Phone,f . . ............ Address ....................... i ... . ......... ............... 73 --- --- ..................................................................... Contractor's Name_.____--.: --...... ----------- ..................................... Phone_ - ! - .......................... e * CE Apartmen —_ Installation will serve: R side t House [:] R --A r;man Commercial E] Trailer Court E] Motel ❑ Other ❑ Nvoc Numbeir of living units: Number of bedrooms %3-. Number of baths'.Z... Lot size ....................... Water Supply: Public system Community system ❑ Private IM Depth to Water Tab). :419 ft. Character of soil to a depth of 3 feet: 'Sand E] Gravel ❑ Sandy Loam E] Clay Loam [5. Clay [] Adobe [] Hardpan E] Previous Application Made: (If yes,date-t. Construction: Yes El No [3— FHA/VA: Yes E] No 3— TYPE OF INSTALLATION AND SPEC I F!�C!AIONS - %, (No septic tank or Cesspool permitted 4 ewer wer is available withinN 200 feet.) Septic Tank: Distance from nearest well ------------ \,--' D�istancle from foundation ---------_-------- Material ............................................. ❑ No. of compartif ments.., --- ....... ... %.Size . ' .... ..................... ... Liquiciclepth .......................... Capacity----------------------- Disposal Field: DistancelIf'n.:::90.-....ance to nearest . /Distt lot line-ZAAonce f rom-fobricl, atioo. --- I� Number of linrs.*% jf '7_m� -------- .- Length of each trench ...... w2� _4e .......... _ ---------- Type of filter m fer�,6'1_��._ Depth of filter material__/,f__"! --------- Total length- 40 Seepage Pit: Distance to nearest well../"---- , ---- Distance fro/ fc,undation.-!".-"_. Distance to nearest lot line./ -------------- Number of pits ....... / --------------- Lining material-- � �_674�e Size: Diarret'er--lReF ----- Depth-_—Z_'T7 __/ Cesspool: Distance from nearest well ----------------- Distance from foundation .................. ...Lining material__-______-_________.___:_____-------. r ❑ aterial-------------------------------------- 11 Size: Diameter ----:-• ............................... Depth ................ ........................ ........... Licluicl_Capacify ------------- -----...__....gals. Privy: Distance from nearest well ------------------------ 4 --------------------- Distance from nearest building......:......................._.._._..... Ej 'Distance to nearest lot. line-- .,,e ------------ ---- .......................... ...... ....................................................... Remodeling and/oreirepairing (describe):____..._wel-91,_1 . --•- ........ ------------------ ----------------------------- - ------------- ----------------------- ----------------------------------------------------------------------------------------------------------- ...................... -------------••---••--•----------•---_ ...... .................................................................................................................. � .............................................. ......... : ................ ............ ................................... I ......... ----------------------- ... I .......... -•------------•-.... I ------------ •----------•----•-------------------------- I ---------I-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State I and rules and regulations of the San Joaquin Local Health District. - ----- --- ;4-9-, ......... .. -------- ------- -------------- ----- and/or Contractor) (Signed) ------------- - BY: ................. . ...... .. ....... . .... ................................. ...... ..----••--(Title)------ ..... �,10- --------------------------------- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... AO.� ....... ..... . . DATE...... t -------------- REVIEWEDBY ............................................. ......... ------....-•--------...-.......----------------------------• ---_.. DATE.----- -•-------••--•--• ............................. BUILDING PERMIT ISSUED......... ... . ................................... .. DATE ............... ....... ................... .............. Al+erafions and/or recornmenclaf ions. . .. ...................... . ..... .. . ...... .............. ....... ........... ..... ........................... ...... ..... .... ................. ............................. ............ . ....... . .. *__ ...... ...... .. ---------- - -------- ----- .......... .......... . ................................................................. ........................... .............. .......................................................................... - ---------- ............ -------------------------- ._ ..................... ............ I ------- ..................... --- - ----------- ---------------------- FINAL INSPECTION BY:..-- .. .... Date ........... .... ...... ..... -------- S JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hasellon Ave. 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California F.P.ca.