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t-UK UN-K-t Ust: ----------------------- ---------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------- - ------- ----------------------- (Complete in Duplicate) -------------- ------------ This Permit Expires 1 Year From Date Issued Date Issued ZS Application is hereby made to the San Joaquin Local Health District for a permit to construct anf q 3_300 _ d install the work herein described. This application is made in compliance with County Ordinance No. 549. �D l O .!r. ^-),e/C_c_ G?— - JOB ADDRESS AND LOC ATI0 ---- Owner's Na µ ----- - _ ------... Phone--- --- Address-----�.---Z• s5_- - ---� Contractor's Name--•-- Phone-'yr_S?7-s.24o� ? Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms c -- Number of baths J--- Lot size --------94-_ 16-4 - - -- --- -••----------------------- Water Supply:' Public system ❑ Community system ❑ Private (g Depth to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand J)4 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: (If yes,date--------------.----_) No PQ New Construction: Yes ;& No ❑ FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- ,J-4- ---Distance from foundation---/Q --------Material-_.;Rd---A4--- No. of compartments--------a-...--____.--Size---- -- - ----- --- --- Liquid depth--------'�� ............Capacify- /� Q--- 1 Disposal Field: Distance from neares well-t,�`p..-.-----Distance from foundation---./a?-�---------Distance to nearest lot line---uF----- .-� �( Number of lines----- _-- Length of each line----49�-QL---------------Width of trench-----,,-?' Type of filter material.--f .------Depth of filter material_,19/.........-Total length-------442-- ------------------- C Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line------.----_--_- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------L:---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___-__------------..Lining material_____.-____-____-------__--------_-_ ❑ Size: Diameter-----------------------r--------------Depth-------------------------- ------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------- ------------------------ Distance from nearest buildin ❑ Distance to nearest lot line Remodeling and/or repairing (describe):--.-- ---_ ------------------------ ------------------------------------------------------------- -- - y -----------------------------------------------------------•---------------•------------------------------------------------------------------------ - -- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -------- --- -- --------------------- (Owner and/or Contractor) BY (Title) --- -- (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --- -- - --Gt.CS -. -- -- ---------------------------------------------------- DATE------REV �T --- IEWED BY--------------------- ------------------- - - ------------------- --- -------'----------- ------------------- ---- DATE---- --•--•-------------------------------- -------------- BUILDING PERMIT ISSUED ------------------- ------------------------------ DATE Alterations and/or recommendations:-------------------- -------•--------- -- --_.----------------------___ ------------------------------------------------•-------------------------------------- ---------------------------- -------------- -- --------------------------------- -------------------------- ------------- -------------------------- ------------------------------ ------ y FINAL INSPECTION BY:._ .---1' - -------------- Date------- ----.-- ---. ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Marlton Ave. 300 West Oak Street t 124 Sycamore Street 205 West 9th Street Stockton,CaflFornia Lodi,California Manteca,California Tracy,California F.P.C d. $ _