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--------------- -------------------_." a2:_®a"""- APPLICATIOIN FOR SANITATION PERMIT Permit No. _.-l.. ._ --- ----------------- ----------- ------ --------------- --- (Complete in Duplicate) ---------------- ------------------- ----------- - Date Issued F""1vij�x - - - - This Permit Ex fres 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 compliance with County Ordinance No. 549. �W JOB ADDRESS AND LOCATION_ 46 ------------------------- Owner s Name Address --------- -- Phone". --------------------------•-------- Contractor's Name-----._.-•- _ ValLal---- Phone /--( _io Installation will serve: Res�e ce Part�t ouse CC-fommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ".r Number of bedrooms .�- Number of laths/k Lot size ... ___ -.._. Water Supply: Public sysfem ❑ Community system [IPrivate [YDepth to Water Table 14 ft. Character of soil to a depth of 3,feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date_..__... -_-_.) No-R--"New Construction: Yes ER /No r LI}� ❑ FHA/VA: Yes ❑ No gj--- 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--------- . ___Distance from foundation............... ...Material...... _- - ------ No. of compartments------ ---" -- F l $ize.--------------- ___:;-----------Liquid-depth' - ------Capacity y . Dis osa! Fie d: Distance from nearest welt ----Distance from foundation..-_-_-1��I-Distance to nearest lot line_.."' ` Number of lines-.I.__-_---.. ' �* ------- --"-""--Length of each line---------- Q-----------.Width of trench---------'3--/ ; ,1 -- ---------------- Type of fitter ma eriai-} 60.----/"_. epfh of filter material..._.1 '_ Total lengfih___.."..... GI_._ —. r Seepage P' Distance to nearest well-----!-. _ Distance fr m f undation...g �r --- Q_.._._.�Distance to nearest lot line-..___"..___.... Number of its... ........ .........Lining material..__ .. .� p / Size: Di�!er.-- e - - - -- ---�---�._.Depth_.--------�� C Cesspool: Distance from nearest well-----------------Distance from foundation____________________ Lining material"__..._.....�___...._. I ------------- ❑ Size: Diameter ------------------------------- Depth------------------`0---------- ------------------Liquid Capacity------------------------.-.gals. l y Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building ❑ Distance to nearest lot line..----- � ---- -•--------------------- -- 1 Remodeling an)/or repairing (descr'be) ---- �/ ---�Q --- i -------•- _ ` -rte` -* 6/ --- ---------- f------------------------ - --------------- ----- - ----------- ----------------------- ---------------------------------------- ------------------- -- - ------------------------- I hereby certify that Ihave ----`- -" """ ""-"-" -------- y y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul s.and!regulations of the San Joaquin Local Health District. (Signed)--------- -t_ r -- (Owner and/or Contractor)i ----- ------------- By:--------- ^"------ -- -------- Title - (Plot plan, showing size of lot, atiori of system in relafion to wells, buildings, etc., can be placed on reverse). . r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------°-- -- --'eI ------------------------------------------------- CF-. 2 DATE --------------- _/---L---- - REVIEWED BY- ----- ----- --------- ----- '....�: - --------- DATE UILDING PERMIT ISSUED--------------r-------------- ---------------------------- -- DATE Alteratiops an or recommendations:-------------------�''-. - sr�f 7 -------------- ---------------------------------,---•-- µ --5 ------- -----�-J .. --------------------------------------------------------------------------------------------------------------------------- _'- -- .._.._...M1V._....---- �. ---.... ......--------....------------------------------------------------------------------------------------------ i -------------------------------------- FINAL INSPECTION BY:...."_ Date----.....__ _. - ------ - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. Y