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rvr vrriLSE: x - --------.- AP PLICATION FOR'SANITATION�PERMIT Permit No. (Complete-in Duplicate) _.--•--------- ----- -------- ------ ----- ------ j This Permit Expires—' Year From Date'Issued Date issued _s_-/_- - Application is hereby made to the San Joaquin Local Health District for a permit to and i stall the work herein described.construct This application is made in compliance with County jOrdinance No. 549. t r JOB ADDRESS AND LOCATION...-- (J . Owner'sName--------------•- -----•----------------------------- ------- ' - Phone �- 'Address.._: � s �Contractor's Name -------------------------- -- - -, ------- ------ -- ...... Phone. rye:Installation will serve: Residence)Kt Apartment House ❑ Commercial'❑ Trailer Court [� Motel ❑ Other [] Number of living units: t I ---.- Number of bedrooms_-- Number of bafhs -- Lot size Wafer Supply: Publics stem ' �-.. '. p ��. -- Y ' Community system[] Private ❑ De th to Water Table ---_.__ ft Charactertof soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑f Cla Previous Application Made llf yes date__.._-__-_-_. Y ❑ Adobex Hardpan [] ._. }t No'r TYPE OF INSTALLATION AND,'SPECIFICATIONS;� _ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E]i (No septic tank or cesspool�permitfed.,if publicsewer is available within 200 feet.) Septic q� ^, Distance from mearesi-veli ?_-Dis#ante from foundation__.--- ...777 (,j{ L --------------Material '°" . No. of compo tments. i ----.___----------------- ---- - ----Size - Lrquid depth Disposal i61d: Distance from earle t well. j_�----Distance•from foundation_-_ID , Capac•ty- `` Distance to nearest lot line----- �--� f lines.-- - Number o _:---Length.of,each.line_ Width R Type of filter material _ of trench+.x�Cf , Depth of filter material-'_-._ _ - g -------------------- - ----------Total len th------- -------- Seepage Pit: Distance to nearest wel!_.__-�_�J- Distance from foundation --_ Number of Its. -- Q--------•.distance to nearest lot Line-_.--- P Lining material.�V_-,/ --_---- Size:•Diameter O Cesspool: ( - ---------------Depth-._ �. r p Distance frorli,n'ares+ well ------------- - 1P ----------- Distance from foundation_.. ._:-___.- Linin material_.._-.----._. ❑ Size: Diameter. - -".-------- -- 9 - ------------Depth------------------ -- --- -- --- --��- -----------Li quid �---------------------- Privy- Distance from nearest well..... q d Capacity----------------------- gals, ______________Distance from nearest buildin ❑ i Distance to nearestlot line ------------------ - 5 - Remodeling-and/or repairing fdescribe)':_ ---- - a .------ ---------------1 /o., - -------- - _ ---- ---- ----------- ----- ---------------- - - ------------------- ---- -- - ------------------------ - ----------- -= ---- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta e laws, and rules and regulations of San Joaquin Local Health District. `i (Signed)- --_ All t . . ntrector) - ---- - - • ------ '--- -- ------- ------- ------- --- -- - - ---(Title)--- ------ ----- -- - (Plot plan, showing s--------------------------------- ze of lot, location of system in relatio o wells buildin , etc., can be placed on reverse- side)._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ ____ _ I REVIEWED BY-------- -------- ------ -------- ------- ---------------------------------------� ------ --------- ------ -------- ------- ------------ DATE ! �� --------=--- I ------------------- ------------------- DATE---- DING PERMIT ISSUED------ i --------------------- - ------------------------------------------ - - DATE ---- --------------------- --- ferations and/or recommendations:.__----!-____---_.-_ -- ---� -------- t -�----------------------------------•- -•----- ---------------------------------•------------------ ------- ------ ------- •---------------------- ------------- ---------------------------------------- ---- ------------------------- FINAL INSPECTION BY:-. -- l }S JO QUIN LOCAL HEALTH DISTRICT 1601 E.Maxalton Ave. 300 West Oak Street Stockton124 Sycamore Street,California Lodi, California 205 West 9th Street ' E.H.92M 1.67 Vanguard Press t Manteca,California Tracy,California r