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FOR..OFF,I,CE USE: .APPLICATION FOR SANITATION PERMIT Permit No. . -- (Complete in Duplicate) Date Issued .3--_:1316 -4� ---- - This Permit Expires 1 Year From Date Issued 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 complia a with County Ordinance No. 549. i JOB ADDRESS AND LOCATI S--b �p Phone Owner's Name _ �_ -------- R+ --- ------ 1 f'� Address----------------------�_-�`-•`-----ROY----- V------ - ---------------•- -------- - _ .. - -- -- - --- - ---------------- Phone------_------------ -------------- Contractor's Name___--___ •---•----••---- -- " Coi-nmercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ 0 .......... ...... __Number of baths ----- Lot Lot size ___--- Numb er of living units: __ __._ Number of bedrooms P ft \ Water Supply: Public system ❑ Community.system ❑ Private l Ue th to Water Table depth of 3 feet: Sand Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑I Character of soil to a No Previous Application Made: {1f yes date_____.___"_------ 1 No New Construction: Yes ❑ No FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ;,, . . �,rr(No-septic-tank=or-cesspool-permiffed-�if-pu61ic-sewer is,available=within 200-feet:)Q�ir—•- �--^�-r~ ' _.__Distance from foundation_._,.-----Material---- Distance Septic Ta k: from nearest well___-_. d _- No. of compartments--.__`2.--- --------Size-- --XIQ__X-- ---Ligwd depth-----� -----Capacity.__1----- Disposal Field: Distance from nearest well___�0_- --Distance from foundation___/0----------Distance to nearest lot line____-________. r oa Number of lines- -- ------Length .of each line__ trr Width of trench____________ _____ --... -A ----.De th of filter material__--.-1 ----Total length____-.___- ------ I Type of filter materiaL_�o .�- P � -- Seepage Pi#: Distance to nearest well---__.____________---Distance from foundation--------------------Distance to nearest lot line-_._______:__. ❑ i P g ------- ------------Size: Diameter------------------------Dept h-------------------- ---- umber t D sta ceofiomsnearest-well Linin mpistance from foundation._--_..__..-------.Lining material_---------------------------------- Cesspool. -----._Li Liquid Capacity_ 9a ❑ Size: Diameter----- -------- --------- ------- --Depth----------------------------- ---- -------- 9 P Y--------------- --------•- Distance from nearest well------------------------------------- Distance from nearest building___._--__.__-------------------------- } Privy: "- ❑ Distance to nearest lot line----------------;--- e,.. I Remodeling and/or repairing (descnbe).__J?_e. L ------�?i`I-sn_aGG -------Y_rte ------------- ------------------- ---- ---------------------------•---- I •---•------------------------------ -------------------- .. .. I hereby certify that I have prepared this application and at the work will be done in accordance with San Joaquin County th ordinances,_,. tats .landYrule and regulations of the San Joaquin Local Health District. } r and/or Contract {-' caner a or ( - - I ..- Signed}_ - ------- -- - ---�L (plot plan", showing size of,Iat, location of system in relation to weI , buildings, etc., can be plated on reverse side e FOR DEPA MENT USE ONLY ,,. ------------------•' i -DATE------- �- APPLICATl01� ACCrEPTED BY----- � --V- - �-� - ' ------------ ---•--- DATE--------�----------------- - -------------------- --------- 1 REVIEWED BY ........... -- ---------------- -- --------- -------------=---- ---- ------- DATE------------------------------------ ---------------------- BUILDING PERMIT ISSUED------------------------ ---- - -- ----------------------------------------- ---------------- Alterations and/or recommendations: ___________________�-- ---------------------------- ------------------------------ ------------------ ----- ---------- - -------------------------- [ FINAL 1NSPEGTION BY- --- -- - ------ - Date---- ---- ------- ---------- - ------------------------------------ SAN ------ ------- ------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,Califorift Manteca,California Tracy,California Stockton,California `