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rVkjU.rrl USE; � �—»r r ----------------------------------------_- ------------- F APPLICATION FOR SANITATION PERMIT Permit No./_1414rz -- ---------------- ------------ ---------- ----------- (Complete in Duplicate) ------ ---------- -- --------------- This Permit Ex ires I 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 2-2-o herein described. This.application is.-made jn_compliance,vyith County Ordinance No. 549. JOB ADDRESS AN LOCATION!t ,,_ - _ - - r'.p �----I��t �------ ..... _VV---- Owner's Name----- �-pQ. ------------ Phone Address------1�17 __-. r'�' U U- --------13.2-----------1!_. f9 = Contractor's Name--- C -------- _ Ph . Other ---- Installation will serve: Residence �� Apartment House ❑ Corrrmercial ❑ Trailer Gourt Motel El Number of living units:.-J---- Number of bedrooms a Number of baths _� � — — ❑ ----- Lot size-- G�-�-�__�--'_�----------------- ----- r Water Supply: Public, system E] Community system ElPrivate Depth to Water Table /10_ ft. If Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ®Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ©-- New Construction, Yes R"lo ❑ FHA/VA: Yes ❑ No ©' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if.public.sewer is available within 200 Septic Yank: Distance from nearest well--- I -Distance from foundation------ -Q-----.Material..6Q/Y L`J No. of com artments___-. n � compartments----.2 ------ --Size_-3.�-�---X-�Liquid depth-_.��•� ---.CapacrtY------d�_��---- Disposal Field: Distance from nearest wellSO-----Distance from foundation__.Ip__..___.Distance to nearest lot line_______._____ ^C" Number of lines--------`-----------------------Length of each 4: line-------61_-- -«-----Width of trench-------9z /It _r-----.- �e1 Type'-of filter material _Q r --_Depth of filter material._.__- -----Total length---------- __�1_-_-_-- Seepage Pit: Distance to nearest well-___->'r__0___..-_Distance from foundation--___ / ---------Distance to nearest lot line__.____•-_.._ ' ®� Number of pits-I._f______________Lining material---A010� %----Size: Diameter._y_XI,�---Depth___... _r�_ Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material__..___...___-- ...___._ •I ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid CapautY--------------------------- els. g Privy: Distance from nearest we11___ ...._Distance from nearest buildin --.... g----------------- Disfiance to nearest lot line___-__.__.-_______ i 1 Remodeling and/or repairing (describe):------ --------------------------------- --------------------------------------------------------- - -- --------------------- ---- - _. I hereby certify that I have prepared this application and Mat the work will -be done in accordance with San Joaquin County ordinances, Stat laws, and rules nd regulafions of the San Joaquin Local Health District. {Signed) r.PJ � --- --------------- ---------------- � ---- -------- --------------- ------------ ---(Owner and/or Contractor) By:------------------------------------•--------------------------------------------------------------------- -------------- (Title - -- (Plot plan,showiri4 siie of_1 t;location o system in Felatio'ri—to-wells buildings;etc.can'be placed on—reverse side). FOR DEPARTMENVUSE'ONLY ' APPLICATION ACCEPTED BY----__- - -- --. R -------------- ------------------------------------------------------- DATE cl`2 -b-S REVIEWED BY DATE__ BUILDING PERMIT ISSUED--------------------------------------------------------------•---------------------------------------- DATE --------�- Alterations and/or recommendations:_________________________ FINAL INSPECTION ' Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 123 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. ,r