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FOR OFFICE,USF:; NWII / _ ..... ...- _ _ 2_ .� APPLICATION FOR SANITATION PERMIT Permit No. .../..cJ �� l (Complete in Duplicate) o ----------------- ----------- ----------=IM.. Date Issued �:___ This 'Permit Expires 1 Year From Date Issued Application is hereby madei�to the San Joaquin Local Health District for a permit to construct and install the work herein descrUi d. This application is made in compliance with County Ordinance No. 549. g JOB ADDRESS AND 1 —11 ._.... � °`�' f.Sp (O� .�- J r. �M �----------------- ---- ... .......I 'k ' �C�E L`l s -- i�Z -------- Owner's -----Owners Name . _ - ----------. Phone------------------------------------ Address ----------------- �6... Contractor's Name.- /-�' 1 �� 64 - ---------------- ------ Phone----------------------------------- Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L❑ i Number of living unit's: -��—Number of bedrooms 1Vumber of baths _j... Lot size ------.......................__--...____,_-_.._-..-..-.--- C Water Supply: Public systeIm ElCommunity system ElPrivate e�th to Water Table 4r-,45"_ft. Character of soil to a depthof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made:i (If yes,date--------------------) No ©--_'New Construction: Yes 9—i10 ❑ FHA/VA: Yes [] No Q---, TYPE OF INSTALLATIONAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). CSept7c , ic Tank: Distafrom nearest well..-. __-----Distance from foundation....... .a..'-___.Material-. __ ............... No, of compartments----------- -.-.--Size.. ,z __-J� ..Liquid depth__L �/ --------Capacity.---Y_C'_0--- ..-. I Disposal Id: DistanceI�from nearest well------ Distance from foundatior/� ____.Distance•to nearest lot T u ebof of lines - Length of each line. -------------------------Width of trench-. .�` ---------------- Type filter material../j,-1___1&- Depth of filter material- .°/ .Total length---------- ex-_:f�------------------ See a e it: Distance to nearest well le e- D":stance f m foun ation.-- d �� P 9 -- ----- ---- - - _.v...._..Distance to nearest lot iine._u.._._..... Number of pits- ..........._Lining material../ i4C-VSize: Diamete r.--?-."�'-`'-.---Deptn__..---,�-4�.', Cesspool: Distance from nearest well----------- Distance from foundation__________ _______Lining material- ------------------------- r ❑---, Size: Diameter----------------------- --------------Depth------ -----------=-------------------------------- Liquid Capacity Privy: Distance from nearest well---------------------------- --------------------Distance from nearest building.---------._-_-----------------.---------- E ❑ ,ta nearest lot line; ----------------------------------------------------- ----------------------- --- -------- p I 7 istance� Remodeling and/or re airin describe , ------_ ---------------------------•-------- ------------------------------------------------------ --------------------------------------------------------------------------- --- ------------------------------------------ ---------------------- ---------------------------------- ---- '-=------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have preps this application and 4hat thea woik willrbe dot=e in accordance with San Joaquin County ordinances, State laws, d �les an re at' ns of the San Joaquin Local Health District. (Signed). > ------------ (Owner an /or Contractor) ---------------- BY ------------------------- (Title - ------------ - - - -- - ----- ------ (Plot plan, showing size of lot. ion of system in relation to wells,`buildings, etc., can be placed on•reverse side). Ir. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t DATE ` Jyl...... Pr - ............. REVIEWEDBY--------- ----- --------------------------- --- --------------------------------------------------- DATE BUILDING PERMIT ISSUED_A DAA'E--------------------------------------------------------- Alterations and/or recommendations:f�z��%._....�'�c� - �i� . -------------------- fM -- ------------------------------------------------ �- = -------------- --- I----•----- -------------- ----------- ------------------ ------------------------- ----------- --------- ------------------------------------------- ------------------- l� FINAL INSPECTION BY :� J'� 'f e' Date---------f� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.Cfl.