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FOR OFFICE USE: - -- --- --------- - -------- -- - ---------------------------- ------- ........ - - - -- APPLICATION FOR-SANITATION PERMIT Permit --------------------------- -- ---- --------------------- (Complete in Duplicate) p Date Issued This Permit Expires 3 Year From Date Issued t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 549. l +' � JOB ADDRESS AND LOCATION___' .___ , -.------- j} 1� ;Owner's Name-= illy` �_ = �` I Contractor's'Name--ow -- .L - :- .�-'-------•---------------------` --------;------------- ---------•----------------------- i <. ` --------------------------------------------------------- Phone----------- .......-- --- Installation will serve: REsidence ]fApa tment House ❑' ComZnercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_t___ Number of bedrooms _'3__ Number of baths 'LLot size _11APP_t -.-----1__-_--ACRE—_ 4 '� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-- - ft. 3^' 'I�Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SanTdy Loam ❑ Clay Loam �)ay ❑ Adobe ❑ Hardpan if I Previous Application Made: {If yes,dote_I. ....... ..-----.) No New Construction: Yes E---'Iqo ❑ FHA/VA: Yes RT-_-NO ❑ \ (—-TYPE-�QFANSTAL-LATION ANDTSRECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availab<within 200 feet:) Septic nk: Distance from nearest well_..,�7----.-_Distance `from foundation-----/ :__ Material-------- if No. of compartments-�_) ---•----------$ize._._Lz-`'��-;1�----Liquididepth-------4---------------Capacity--- -VO-Q--- � Disposal Field: Distance from nearest, __. weil._.S�__ _Dis#once from foundQ ation.� ��"`��`�Distance to nearest lot line.__.____.._.. ]� Numberiof lines-_-__-----f�__ _______-------Length of each line......,.. --'I'- ____..Width of ire ch'.___.2Y_If__.____ ` Type of filter material;-_ 0- �-_-Depth of _filter materia------ length___-_,_____,lQ�__----------- SeF.page Pit: Distance #o nearest well----/_D-0---------Distance from foundation---10---_--__-.Dist n e to nearest lot s = Ces�P __Lining material �O0<� Size: Diamete . ....... .....at__Depth,}).y -----1i__-- I l: D stance from Number of weDis#a'nee from foundation------------------- Lining a#erial_... ----------- '� ---------- ❑ Size: Diameter--------------------- ------ -------Depth------------------------------------------- --------Liquid Capacity-� 981 � Privy: Distance from nearest well------------- ____________________________Distance from nearest building..__ ❑ Distance to nearest lot line-------------- ----------------------- Remodeling and/or repairing (describe):.....-- ---L-L-E_4-------------- ------------•------------ ------------------•-- -- ---------------------------- ------------------------------••-------------------------------------•-•-------------------------------------- ------------•----------------------------------------------------------------------'------------- • t S ---------------------------------------------------------------------------------r----------------------- -----------------------------_------------------------------------------------------ -__-___._.-____-__--_-.---_----__.--___--___-_--._.._____-___--_--.--_-.._ - f xJ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin,Local.Health Disfricf. d (Signed} j---- ----------- ^,� -.-..,.�_ ---�- �----�---r--- :..---.- -:-.----�-------- _------_- -�---- y(Owner and/or Contractor) ----------------------------------------- -- ------------------------- -------------------- ------- (rile) �.. .r (Plat plan, showing size of lot, location of system in relation to wells,'buifdings, etc., can be placed on reverse side). FOR DEBAR EN7 USEjONLY APPLIGAT.IOM CCEPTED $Y r.._ .F.C r,---- --- ----------------------------------------- ----- DATE--------/ _:13_'47:-------------------- REVIEWED BY --------= ---------'•-----------------------------`----- DATE------ ' BUILDING PERMIT ISSUED------------------------- - ------- --------------------------------- -- -- , -- - - -----------=---- DATE.---------------- ---------------------- ----------------- ' :Alterations and/or recommendations-------------- -------------- - t � .,-..-.-...-1-- ----------------------------------•------------- - - . Z. ------ - { --------------- `` --- ------------- ---- ----- --- },FINAL INS P -------- rti " Date -- --------- ------------- �. �7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i k t Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.