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FUR OFFICE USE: ------------------------------ --------------- -. -------------------- JAPPLICATION FOR SANITATION PERMIT Permit No. .PI.4�J�Z ---- ---------------------- -------------------------- [Complete tri Duplicate) This Permit Ex ires 1 Year From Date Issued bete Issued _- ._ -GGA Application is,hereby made to the Sari L.._aquin Local Health District for a permit to construct and install the work herein described.' This applic;riis.m�de c mp+e it Co my rdinance No. 549. JOB ADDRESS AND LOC TION...... ... ..............___ Owner's Nairne-- ---- 4 z ------------- ---------- -- Phone------------- --------------AV , Address-----------------� ;;� 1 Contractor's Name---------------------------------•----------- --- --------------- Phone.----•-•---••--------------•----- `Installation will serve: Residence ❑ I Apartment House ❑ Commercial ❑ Trailer Cerovr:f fi Motel ❑ Other ❑ Number of living units: _------ Number of bedrooms -------- Number of baths .__I.__- Lot size . K_1%k-__ Water.Supply: Public system ❑ Community system ❑ Private R1 Depth to Water Table J-5- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam Clay ❑ Adobe❑ Hardpan 12 i Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ,.;I-TYP_E40E-,F-INSTALL-ATION.,AND..SPECIFICATIONS - - -- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-l .01 Distance from foundation----1.1.y........Material----� s-------- No, of com artments-----_�--------- ---Size- --t--�-� - �------..Liquid � depth---4-------- ------- Capacity..1-M_17---- Disposal Field: Distance from nearest well- 0----_-...Distance from foundation..!9---..-._.---Distance to nearest lot line..------------ ?:0 1p 4 f Number of lines --------------------------Length of each line.__, ------------------..Width of trench----- ---------------------- Type of filter material-At ----- --------- of filter material:-__ `_ -----------Total' length--�1�_'___.______________________ Q I Seepage Pit: Distance to nearest well..)_ -------____-Distance fro foundation-_�. '._._...-_. Distance to nearest lot Number of pits........____-____Lining material_ _%fir.....-.-.Size: Diameter---- p l + Cesspool Distance from nearest well.................Distance from foundation........__---------Lining materiaL..-______-____--_-____-_______•_-. ❑ Size: Diameter------- ---------------------- -------Depth----------------------------------- --------------- Liquid Capacity----------------------------gals. Privy: 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 laws, and.rules and regulations of the San Joaquin Local Health District. (Signed)-- � �"': .�-�ras�.-. _...- .(Owner and/or Contractorl . -'- ,s•'=�,irw++Ma,��srrRrw r�.�.,e��w��.�,.:_. ._ ,. r, BY---------------------------------------•---------------------------------- ---------- --------------------------------- .---(Title)--------- --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- .� DATE - REVIEWEDBY------ ------------------------------ ---1---------------------------- ------------------------------------------ DATE ----------------------- BUILDING PERMIT ISSUED--------------------------------------- ------------------------------------------------------- DATE---------- -- , Alterations and/or recommendations:. ---- - -------------•------------------. - ---------------------------------------------------------------------------------•---- ------•------------- ------ ------------------------ ---------------------------- ------------------------------ ----------- ---- t FINAL INSPECTION BY: �4 ------------------------------ Date-4.7- --j�4------------- ---- ---------------------------------------- 5 t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street,. 124 Sycamore Street W 205 West 91h Street Stockton,California t Lodi,California Manteca,California Tracy,California F.P.0 O.