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v>< vrrik_r uJt: -- ��- - . - ----- - APPLICATION FOR SANITATION PERMIT Permit No./._��T�___ (Complete in Duplicate) --------------------------------------------------------- This Permit Expires i Year From Date Issued - Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to c struct and install the work herein described. This application is made in compliance with County Ordinan No. 549. f JOB ADDRESS AND LOCA M" N _ / - -- Owner s Name " U L1 ,--1 - Address -- = Phone__ e7G Ph- (GIP Contractor's Name-"""-___"_" "_"--" __" -------•-••- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "� Number of bedrooms -"-� Num_ber of baths - -"-""_ Lot size __ Water Supply: Public s stem � - ""� - ----------------------------- y ❑ Community system ❑ PrivateDepth to Water Table.5p ft. Character of soil to a depth of 3 fee+: Sand [IGravel ❑ Sandy Loam-[]. Clay Loam ❑ Clay ❑ Adobe$ Hardpan E] Previous Application Made: Of yes,date-------------------- No '_ New Cons+ruction; Yes ❑ No Nr FHA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well----------_------Distance from foouundation--""-_ _ O�fCf.S-!►� No. of compartments--------------------------Size - Material --------- •------------------ 10' ----- Liquid depth ------ ........Capacity----------------------- ---Field; Distance from nearest well_.�•�.-_Distance from foundation"7""_-"" --f Number of lines-" �. �� ------Distance to nearest lot line_ _�.----- ---__-Length of each line_"" __"___"--._.Width of french-2- 11 Type of filter material------------------ ------------------- Depth.,:o .{ilt_e,material `. Total length.- Seepage Pit: Distance to nearest•well---------------"------Distance from foundation Number Off ---._-".Distance to nearest lot fine � i�,umber of pi#s------------ -------Lining material---- ---- --- I-----Size:•Diameter------------------ ---Depth----.---------------------- --_'_-Distance' �------- -------- -------- 1 I Cesspool: Distance from Weare+`well:"°":_:-"--f."--Distance'from foundstion-- y_-" -."._.Lining material"".-_---""__" ❑ Size: Diameter-------- -"-- ------------ Depth ------Liquid Capacity-"------------------- gals. .: „� ,--. 4 Privy: Disfancefrom nearest well___"_- '"-___-"__-" ---Distance-from nearest buildin Dista ce!to nearest lot line-----------_-"-_ I i f_ g ------------------------------------------ Fl --------- - ------ Remodeling and/or repairing (describe):.-----_ -"---- --- - •-- ----- t ----- - ----------- �- _ ---------- -- - ------------------------------------------ -----------,- - ------------------ ------=--------------------------------------- --------------------------- ------------------ � _:.,:----------------------------•------ w: �', -----------------'--hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S aws, 'a d rules and a ulatio s of t F Joaquin Local Health District. �r ) . (Signed e -- -- -----' ' (Ownern Contractor) a d/or ` (Title)- __ _. - --F---- "-.- \ {Plot plan, showing size of lot, location of system in-relation to ells, buildings, etc., can be plat on reverse side). e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDIBY- `` -------- •-------# DATE- _A_1_ _S- _ REVIEWED BY 't # s.--------- --------------------' ----- ." DATE_ BUILDING PERMIT ISSUED---- __:: - --------------------- ------} DATE------------------------•-- Aterafirons and/or recommendations:.__"""-_-.:__." F� QIW - ---------------------------- ----- - a /J -_------ ,,. ------------------------ -_�,y�.�t'-° ----�'�__ . _.. _ _ "_. .-"+� �� _ 0 µA--" -"" -.__-__-"".-" -------------_--__--- • I _-"-"-.-.-"---------------------`--I------------------------------------------- FINAL INSPECTION BY:. " - Date M --------------- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT /1401 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street F.p,Cfl. Stockton,California Lodi,California Manteca,California Tracy,California