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------- -- --- r- r< v rl�t uat �'`� 6 ---- - - -----2- �--- 1_ 1>>`_ _ ___________________I4_ _-...-__ APPLICATION FOR SANITATION PERMIT Permit Noo............... ------------------- ------------------------- ----------- (Complete in Duplicate) � - ------ This Permit Ex ires 1 Year From Date Issued Date Issud ...5 7_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATIO ? R ;t � �_, _, '�. .r> -.'� 777' � 4 ------ ------------------------- FlJwca.� --t_---- Lr� ..�. Owner's Name--AA-ii. ;-_A---.-- -b~ �.� '�r� '1�sl f� ------- ---------------- ----------------------- - ----..... ._ Phone---------------------------•--...._. �-�- Address . — \OT -•------------------------------------------ Contractor's Name- ------ ` Phone----- -•--- Installation will serve: ResidenceEy Apartment House ❑ Commercialler Court ❑ Motel ❑ Other ❑ Number of living units: _J-... Number of bedrooms ..ZNumber of baths .,/.... Lot size ... ___-. -C_✓�.;r� -__-.......__._ Water Supply: Public system ❑ Community system ❑ Privatepth to Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam E] Clay [:] Adobe © Hardpan E❑ Previous Application Made: (If yes,date_________ ____ ____) No / New Construction: Yes 0 No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic #ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_.------------------Material ❑ No. of compartments----- ---- - ----------Size--------------------r-----------Liquid depth-------------------------.Capacity----------------------- Disposal ield: Distance from nearest well --_--...Distance from foundafonj-C)..r--------.Distance to nearest lot l�e;--/ -.....N Number of lines-------- ------ ----------------Length of each line- �-_-----------------..Width of french---= -- ---------------------- VA Type of filter materia..___.-�� - --Depth of filter material----1.8_'1----------Total length_--_ -------- Seepage �,if: Distance to nearest well------------___Distancnfrom foundation----?_P_'.--___..Distance to nearest lot Ltd dumber of pits.-_ ... ......... .Linin maferial___�G!�_-� Size: Diameter_ ,t-___-...._Det h_ Cesspool: Distance from nearest well __-------------Distance from foundation -,--------------_.Lining material...............---------------------_. + ❑ Size: Diameter- -- --- ---------- ---- -----------Depth--------------- ----------------------- ----------- Liquid gals. qPrivy: Distance from nearest well---------------------------------------- _ _-- Distance from nearest building-__._ ---------------------------- ❑ Distance to nearest lot line--- ------------ ------- -- ----- - --------------------------=---------- Remodeling and/or repairing (describe) -- ----------------------------- ------ -------------------- ------------ ------------------- ----- --------------------------------------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-law , and rules a gula#ions of the San Joaquin Local Health District. (Signed) - ------ - Q'11 ----`---------------------------------------------------------------- Owner and/or Contractor) ( / ) By:---------------------------------- �� Title - - j �' 1�--- ---------------- ( ) (Plot plan, showing size of lot, IoG ti n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------O-r---------- ------------------------------------- -- ------------------- DATE REVIEWEDBY----- --------------------------------------- -- - ---- ----------------------------------------------•----------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------•------------------------------------------------------- DATE Alterations and/or recommendations:.-_± _ _ ..-J . .- I- _----- -� Riay _-._ ZSt' ' -Zc---------- � R. -----�k .9---------ivx: C _ ------------------ - ------------------------------------------------------------------------------- -------------------------------------11------------------ ------------- - ------------------------------ -------------------------------------------------------------------------------- ----- -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--___4_,...�i � - --------- Date-- SAN ate-SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street / Stockton,California Lodi,California Manteca,California Tracy,California F.p.co. •/ a � s