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r Ivrri� st: a t ----------- --------------------- --,_--- APPLICATION FOR SANITATION PERMIT Permit No. . ...-� I - -------- ----------------- --------------------------- (Complete in Duplicate) ------------------------------------------- - -- This Permit Expires 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 work herein described. I This application is made in compliance with County Ordinance No. 549. _Cr __�:.----6_C( --� ---------------- JOB ADDRESS AND LOCATION_... f Owner's ame_ ____ - Phone---------7-�--��-- t Address ---- ' " a - --- -`-`- ` 4 / Contractor's Name----- �_.-�k3____-- - r�_tL.+� _ ___-- _-- t�.�..l�-- ---.fl.�+-------- Phone__ �7a?3f-- Installation will serve: Residence ment House + Commercial Trailer Court Motel Other Number of living units: Number of bedrooms Number of s ___ Lot size-rr-�- '�_'-- _____________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table !�a_e2ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date---------..---------I No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r tib k: Distance from nearest well_________________Distance from foundation----.---------------Material___..____._.___.______._______.____.__:.-__-____. No. of compartments-- ------------ f Size--------------------------------Liquid dept------------------- Capacity----------------------- Id .,...Distan.ce,from t�earest.we{ �__._ ©ist�t e.from.foundat' n_ _n _. ff_ _ .._.Disfance to nearest lot €,a_ ®__... -------- d- 1 Number of lines - ��----Length of each line--90-- ¢� Width of trench--'241w.- -------- �„ - Type of filter material_- _- - Or'. Depth of filter material___._ Total length------------ -- -�-_-_-G�_ fat Seeps a Pit: Distance to nearest well 1049 I)_-Disfanc from found ation_�J.7____-------Distance to nearest lot line... Number of pits....1______________ _ining4maferial,_�J Size: Diameter__5S_7* �,6."beptn____..Z� Cesspool: Distance from clearest well ______---------__Distance.fro.r)yfoundafon.-_----------------.Lining material------------------------------------- 100 ❑ Size: Diameter D,� th• -----.. ------------------------------- Liquid Capacity ---gals. G Privy: Distance from nearest well___. _ _ ______________ Distance from nearest building ----------------------------------------- _ _ _ _ Distance to nearest lot lin :- -__%--- ----- ---------------------------------------------------------------------------•-------------------- "\ delin aY or*r`e repairing. describe %" en yo 9 P 9 (describe) ..� -------------- -------------------- ---------------- --------- -------- --------------------------------------•- + .. ------- - ------- ------------ - -- - -- - - - --- -- -------------- L -------------------- ---- -- ----- ---- ----- - -- -- ?. - --------------------------------------------------- I ---------------------------------- ----- I hereby certify that"1'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and—rule—sand regu14.figA the San Joaquin Local Health District. oe (Signed) ��.k' - - --------- . ----- ----;Z . - ontractor) IN: fi iT r y. (Title} Y• -. ---------- --- - - ----------------------------- (Plot plan ishowing size of lot, location of system to relation to ells, buildings, c., cr be placed on reverse side). 7 FOR DEPARTMENT USE ONLY 1 —APPLICATION ACCEPTED BY-------- ----- -/'------ ` ------------------------------------ DATE ------ REVIEWED 3 REVIEWEDBY-------------------------------------------- . ----- --- - ------------------------- DATE_._ - BUILDING PERMIT ISSUED------------------------------------- --------------------- --- DATE------------------------------------------------- ---�----- Alterations and/or recommendations: ti �' �h------------ C� -y` „ ;fid{'a, s-.`r `� -------------- re— .,. .�- ------ --------------------•-------------- ---_-------------- ---•--------•-----.... ------------------ ------------ - --------- -------- ---- --- ---------------------- -------------�= --------------- ------------------------------------------ •----------- ---- ----------------------------- ------------- = 4K FINAL INSPECTION BY:. --- ------ - Date---------------------- - - -- - - -- ---------------------------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ra,