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c+vR VrrlLt 11JC: _ ---- - "— .- f p 5.4 ------------ _______ -----____- APPLICATION FOR SANITATION PERMIT Permit No. � •W _ ---------I------------------------- -------------_---- (Complete in Duplicate) ik ------------------ -------- ------ -------------------- This Permit Expires 1 Year From Date Issued Date Issued .�_:1l:-�a� 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. r JOB ADDR&S ANb OCATION-------------- 1-_ r --- ----- - ------------ Owner's Name--------- -- ---•- ��Q� - -- - -------------------------- `- one.---------•--------••--•----------- Contractor's N eAddress------------------ ---•- --��_ --- �` __ _ _ _ f-------- - ---- -- ----------- Phone_. ... -•-- •---- ----------------- ------- - -----------•----- - t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other, ❑_ Number of living units: __� N ber of bedrooms . f J � Number of baths __ _-__ Lot size _ _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table (0 ft. Character of sail to a depth,of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ❑ Adobe Adardpan ❑ Previous Application Made: .(If yes,date__.__.----:___.___) No E9-'__N_ew Construction: Yes No ❑ FHA/VA: Yes ❑- No ®� ' TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic > -- Distance from nearest well----_~1___Distance from foundation-�� Mate ial � '� r No. of compartments------,. -------------Size fol_-V.__QLiquid depth------- ----------------.Capacity, - Disposal Distance;from nearest well-------._ Distance from foundation-_�a-._�----Distance to nearest lot line___�_T-�-- Number of lines-------/_-______f--__�/_EZ? -____Length of each line_-_--_��'__�_�--- --_---.Width of trench._c;2_y__ --__---_ ------ Type of filter.material____ Z --_, epth of filter material_- �__-_---"-_Total length_---__ (-:%----- Seepage Distance to nearest-well__-1---_---------Distance , m f undation__ Q-- _.Distance to nearest lot line----------------- ma T Number of pits "---------Lining terial'11Size: Diameter- ��- - ---Deptn_- Cess oof: f y p Distance from nearest well___-_________-__Distance from foundation ___---_Lining material--___--____________ V• ❑ Size: Diameter--- --- ---------------------- ------Depth----------------------------------------------- -----Liquid Capacity----------------------------------- Privy- ------•-gals. Distance from nearest well------------ _--____--------------- ----- ------Distance from nearest building -....� <, .. '... T� .. 9 ----------------- -"- ❑ Distance to nearest lot line__.__..___.__________________ Remodeling and/or repairing;(describe):------------------ - p�4� -----------•------------------•------------------"-----------------------------------------------------------•------------------------------------- = - ------------ I ---------------------------------------- --------------------------------------- -------------------------------------------------------------------------------- ----------------- _T -- ------- ---•-----------------------------------------------•----------------------------------- ------------------------------- -------------------------#--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, a d rules eguiations of the San Joaquin Local Health District. (Signed) --- a '! 41 ------ ----------------------------------- -------------- ----------------- , 4 Y T caner and/or Contractor By: Title __ �i (Plat plan, showing size o lot "ocation of system in relatio ls, uildin s, etc., can(Title) 9 p on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - ----- -- - ------------------------------------- DATE - --------- -------------------------------- UILDING PERMIT ISSUED-- ----- - - --- ------------------------ ---------------------------------------- --- --------------------------------------------------- DATE------ -------------------------- ----------------------- DATE---- - --b�-- ----- -G'�Alterations and/or recommen-dat-i-o-ns:__'- : - ------------------------•----------------- ---------------------------"----------------------- --- ------ --------- ------- ---------- FINAL INSPECTION BY:.... 'f - - ------------------------ Date------ t - k; - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1441 E.HareNon Ave. " 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy;California ` F.P.C Q.