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1-UK UI-FIU UU: f -43-1------------------ ------------- --------------- �'? Q 5_____________ ____��=3�'-------.-. APPLICATION FOR SANITATION PERMIT Permit No. Zl l.__.-. --------- ----------------------------- ---- ----------- [Complete inl'buplicate) This Permit Expires 1 Year From Date Issued 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. f / , JOB ADDRESS A09LOC fON_____ J - -------------------------------------- `` -- ------- Owner's Name -• ---------------------------------- -------------------------------------------- Phonlez/ --------------- ---------------or- ------- Addres rwsrcrsr-__ ------------ -------------------------------------------•--------------------------/---------- -- ------ Contractor's Name------- I-- -- - -------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- Number of bedrooms _ __ Number of baths --f-- Lot size _-._ Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I f Septic T k: Distance from nearest well-s_-------Distance from foundation---44_ --_..Materia_ ------------------------------ No. _______________-.--._.._-___ No. of compartments-..¢Z-------------`--Size--- _ -------Liquid depth--------'/' -_-_____...__.Capacity--ffev. !. Disposal Feld: Distance from nearest well.,45-0-------Distance from foundation--12.0-�-.--Distance to nearest lot line------ Number of lines_--.- /--_ Len th of each line- __ .._1 `� -- 9 �� -- ---------- --Width of french- �-�-.--- �� Type of filter material____! QG/ ---Depth of filter material__/9--._..__----Total length__--__.-.-.__--_--. ®---_---__.- Seepage t: Distance to nearestiiwell-1p� .___---Distant om foundation--------------------Distan`e to nearest lot line-_.S- --._._ Number of pits.----L- ------------Lining material-d��--_Size: Diameter... -,3....._.._.-- Depth--.--4R1--j------------ Cesspooi: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_---__---__-.--_-__-----.._.__-.---. r ❑ Size: Diameter------ ------------------------------ Depth--------------------------------------------- -----Liquid Capacity--------------------------gals. `tVJ 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, 7ae laws and rules an regal ions of the San Jo uin �LoqplHlealth District. (Signed) ---------------------------------------- ------- -------- caner and/or Contractor) By:-----------------------------------� --=��----- ------------------------------------(Title)------- ------- (Plot plata., showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - ---------------------------- ---------------------------------- DATE------------- S` ----------� REVIEWEDBY- ---------------------------------------- - ---- ------- -------- ------------------------------ -------------------------- DATE---- BUILDINGPERMIT ISSUED------------- ---- --------------------------------------------------------------------------------- DATE.- ----------------------------- Alterations and/or recommendations:_.../ --'(�--_-__--___ ---------------------------••---------------------•----------- --------------- ---------- ------------------------- ------------------------------------------------------------------------ -------------------------------------------------------------- ----------- ----------------- -------- ------------------------------------------------------•------------------------------------------------------------------------- - -- ----------------------- ----- FINAL INSPECTION BY:- --- - - ------------------------------ Date---------------- / ------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Huxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca.