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5 rUKU11-1U u�)t: ___________ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- -------------------------------- ------------- (Complete in Duplicate) -------- This Permit Expires ] Year From Date Issued Date Issued _ �. ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application,.isrmade,in-complianee with County Ordinance No. 549. �S'�_ Z,:F,p..3,3 JOB ADDRESS ND LOCATION = ---------- 1 .. l!��__--''11 ------ 0F.. � 1�1f _ - d jt _>T_. _ - �`: - Phone------------------------------------ Owner's Name------- _ Address--------- p ...... ------- ---------R-12 N-------------------------- - ------------------------------------------------ Contractor's Name-------•--------'0k4 ( j1 .:: ------ Phone----------------------------------- Installation will serve: Residence WT-Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms . Number of baths -9- Lot size ___________________-____ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ` ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ^ Previous Application Made: {If yes,date----------- ------] No U�r,_ New Construction: Yes �No ❑ FHA/VA: Yes ❑ No Lf 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 a� Distan4e from foundation p f Material_ } No. of compartments--------7------ Size_VX/_40_ 7___Liquid depth_.jj --------Capacity_f-------------------- Field: Distance from nearest well_-5-0..._.Distance from foundation____ Q.______-Distance to nearest lot line---5�______- Number of lines-------'- --- ---- ---------Len th of each line___._- - it --- ref t------- g t - Width of trench i Type of filter material__1�0 --k._____Depth of filter material____.._17 Total length___._____ .______:_ r ___ __________ Seepage Pit: Distance to nearest wwelL_--150'-'---Distance from foundation___/LO•.......Distance to nearest lot : _.._ � Dumber of pits_-__-- ng material_RD_C_K....Size: Diameter_�Y__A:_�.--__Depth...... _-�__�_. Cesspool: Distance from nearest-well-----------------Distance from foundation------------,----...Lining material_--....__________.________----CJ6 ❑ Size: Diameter. Depth----------------------------------------------------Liquid Capacity----------------------------gals. 7 Privy: Distance from nearest well____ -.----Distance from nearest building______________________________________-_. ❑ Distance to nearest lot line - ---------------------------•---------------------------------------------------- }� Remodeling and/or.repairing (describe) ------------------------ -----------------------------------------•-------- ------------------------------------------------------------- 4• ------•--•----- --------------------------------- ------------------------------------------ ---------------------------- ------------------------------------------------------------------------- ----------------------------- -------------------------------------------- - -------------------------------------------------------------------------------------------- ---•------- - -- -------------------------- I hereby certify that I have prepared this application and that the work will`be done in accordance with San Joaquin County ordinances. - S to laws, anrules ga - latioLnlsf of the San Joaquin Local Health District.(2 __(Signe(} � - ___.___(Owner and/or Contractor( r BY•---- sQ= location of semn re -on to we- ----------------------------------------- -(Title}----------------------------------------._....... ter(Plot—tan, showirissize of-tat; sfilafills; uildin bs l p 9 y 9 �etc.;can�-be-paced-on-reverse-side I• - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - � �---- ----------------------- DATE--------, _`_ '.`_ ---------------- --------------------------- --------------- ----------------- REVIEWEDBY------------------------- ----- --------------------------------- --- --------- ----------------------------- ---- DATE------------------------- -- ----------------•------------- BUILDING PERMIT ISSUED------ -------------------------------------- - --- ---- --- ------- --------- DATE Alterations and/or recommendations:.---:------ "- ~ - ------------------------- ----------------- ------ --------- -- = FINAL INSPEC Date------ - `� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street LL 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.F O.