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v� vrnt,[ u0c: '-------.---------------- ------=-r----- - E : � �3 - -------------- APPLICATION FOR SANITATION PERMIT Permit No. _-- ---• ---•-••----- (Complete in Duplicate) --------- -------------------------- Expires This Permit f Year From Date Issued I -Date Issued ---... . --......__.. ' Application is hereby made to the San Joaquin Local-Health District for a permit to construct and install the work hre* desced. b This application is made in compliance with County Ordin rice No. S49. O y ie � ds-,F� JOB ADDRESS AND LOCATION... � [ + Owner's Name..__�"L._E----`� -- � �IL � � .............. / f�� - Phone. hone -W-P... Address_ `I r 'r ! Contractor's Name-,-7---;r-----C>---_ .ct S/ ``........................... r Installation will serve: Residence Apartment House Commercial ❑ Traile Court,❑ Motel Other ❑ Number of living unit Number of bedrooms _ Number of baths _,-..r Lot.size C � Q ` - .. 1049 Supply: Publics stem Community system'lii❑ PrivateQepth to W ter Table _.:._::- ft. Y ❑ Character of soil to a depth of 3 feet Sand ❑: Gravel ❑ Sandy Loam Cla Loam y.. ❑ Clay [-]', Adobe❑ Hardpan Previ ., ou's Application Made: (if yes,date----------- --------) ' No ❑ New Construction: Yes.El NoFHA A: TYPE-OF INSTALLATION.AND-SPECIFICATIONS:,:, ❑ N Yes ❑ No E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nh: Distance from nearest well--sP._- _..Distance from foundation____./P__..__,Material..................... ............. No. of-compartments_ ._-- •• Liquid depth__.._- .-- -_- Ca aci tYDisposal d: Distance from nee) - well - - -4�-._....Distance from founds ' n-___ �j � F • lGl9._.»..Distance to nearest lot line__...__. . Number of lines-A.. "_Length of each line___ F` ' � .�Nidth bf trench _ .!r Type of filter matialr-Depth of filter material___ -!/----.--Total length.__.-S-V-_�-_--- : . Seepage Pit: Distance to:f 66s.t well-----------------------pistance from foundation....................Distance to nearest lot line_..___..._...._ ❑ Number of pith::_= -----------•----Lining material'---------- 1E Size: Diameter__._.. Depth --------•-----•--- Cesspool: Distance from :nearest well-------------____Distance from foundation__________...___ f wr Lining rmaterial -------------•---••---- El Size: l7iam m.Qr-=----------------------------- =Depth'''- ' .-Liquid Capacity gals. Privy: Distance''rom nearest well____-_.___-_ Distance from newest bAdin ❑ Distance-to nearest lot line__._�______._:"'___- ,,. ._.:r. _....-- 9-------•.------••-------••-----•------•--- ------------•---- -y•--••----•_--- _________ _________________ emodelingand/or repairing ldescrib - -- - � ____________ •------_ _y_ = ----------- -• i.• -----------------=•--•---------------------- - --------------•-------------•----•--------- ------------•----------------------- 1 - I hereby certify that I have prepared this application and that'the work will be•done'in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the'San Joaquin Local Health District. (Signed)..----•---------••----••• 1._. �� „�—.;T: �,..;�� r Contractor gY•--•------------............------- � ----=---'` ".. ;�B , �; �� 1 _ .. ;- ! _- - -- =----.-"(Tit e] (Plat plan, showing size.of lot,-location of system in relation wells buifdin -------------- ---------- -- ------------- etc., can be placed on reverse side), r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....- - - -IR+� t ------------------------ 0-DATE J�� REVIEWED BY-----------------•---•----•-•- -- ----- �_ . - - -- ---•----• -•---•-----•---- -- ---------- ---------- ---------• - DATE - BUILDING PERMIT ISSUED................. -- -'- ._ --------•--------• ----------•----• ---------------------._---------•--._ DATE--- � � A erations and/or recommendations:______.`._: ------------------ - == ________________________________ 1 �. _____________________________________ _ _______------------------___.- --___._.___---_____-___--_.___ __.._._._____ •----- f;: -- - ------ - -- ---- ---- --------- ---- -- ------- ---••-•------- _ . `f:INAL INSPECTi©N-$Y,;-. _--- ,i- ----- Date -.. y _ - -- --------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 144 Sycamore Street Stockton,California � loth,California 405 West 9th Street I EB g REVISED S-S9 ><M 5-611 ATLManteca,California Tracy,California AS - 1 � I