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OR OFFICE �N USE: ---- •� ' 4 " Permito- /--- v° APPLICATION FOR_ SANITATION PERMIT -= Date Issued (Complete in Duplicate} "-' ---- ------------------"-.__ -_ This Permit Expires 1 Year From Date Issued •i A lication 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. ool y --- - -------- JOB ADDRESS AND LO AT10N l_---- ----- Phone---------------- x ---------------- Owner s Name------------- --- - - ,• ./ Address- ----- -- ------ Phone_. - ------------------------------------------------------------- Contractor's Other Name____-.____ ---- -- -- - - ote A artment House ❑ Commercial ❑ Trailer Court ❑ f InstaiVa#ion will serve: Residence Apartment Number of baths _ -- Lot size �_ - Number of living units: d°'-_ Number of bedrooms - Depth to Water Table 441t. Water Supply: Public system [Community system ❑ Private ❑ P Adobe Hardpan F Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ _ Character of soil to a depth of 3 feet;, Sand ❑ ❑ New Construction: Yes Y 'moo E] FHA/VA: Yes ❑ No Previous Application Made: elf yes,d��te-.-_--,-- _) No U5 TYPE OF INSTALLATION AND SPEC FICA`fIONS: E (Na septic tank or cesspool.permitted if public_sewer�is a�ailabie within 200 feet.) f . ,g� --------Mate ial �� Septic Tank: Distance from nearest well -------Distancef m(f(oundaati�qu, depth___ _. y ---------Capacity- No. of compartments_.._. .Size --- d " ' � • �Q -a-- Distance to nearest lot mes�' f *may Field: Distance from nearest well_._"-`�-�De�9th of�e each I ne� Q Disposali Number of lines___:----- f^----"- 4 ` fes' To#al 'length s - - ------------------ Type of'f"ilt �inmate-rral .: -----'Depth o 'filter material__ ---- z ! W /__Distance fr m fo ndation___ 1•--- ��s nce to nearest lot line lit i Seepage Pit: Distance to nearest well____11 -- ;. Size: Diameter - �-----r---- P ------- -- - Number of pits...--. ------------Lining material__: _ ,_. .._: -- �_.. �� .. ._ ,-oMfoUn tion -----1 inin mafienal k Distance from nearest well______----"------Distancerfrom foundation__________________ "gals. tN Cesspool: Depth ------Liquid Capacity------------------ ❑ Size: Diameter. �----------------------- ----- -- p '1 _________ ______Distance from nearest building - ante to nearest lot line.-.___.n-------------------------- Priv: . .. Distance from nearest well----=-------------- ----------.------------------ 4 ------- �% ------- -------- - --------------------------------- .1 i Dist -� - ----- -- n - _ _ - Remc eling and/or repairing (describe): '- �"f y t �j / ; i /� G/mow-`-------- J�y .r -----------=------ ------------- �{_____________ __-_ v I hereby certify that I have prepared this application and that the work will:be done in accordance`-with Sari Joaquin County F ordinances, State laws, andrulesand regulati ns of the San Joaquin Local Health District. _Q�r Contractor} a� __ -------- -------------------------------------- Si ned ---- - ( 9 }--------- � .. -------------------(Tit1 _._ r -- gY Plot plan, showing size of lot, location.of..syste rela#ion tb wells, buildings, etc., can be place on reverse side). 4 FOR DEPARTMENT USE ONLY 1 �-S� ---- DATE------ ------------------------ -- ------------ ! `APPLICATION ACCEPTED BY ` F .'_ DATE----- -------- ----- -------------- = ----------------------------------- REVIEWED BY--- ------ ------------- - ---- DA ----- ---- -------- ------- - - t BUILDING PERMIT ISSUED-------- ------------- ----------------------------------------------------- I recommend tans: -- d�- - r Alteratio s and/ -A117 -------------------- -- �' --- Date-------- FINAL INSPECTION BY:------ ----- ------- - -------- -- - SAN JOAQUIN.LOCAL HEALTH DISTRICT * 12A 205 West 9th Street Sy amore Street's r 1601 E.Hatelfon Ave. 300 Wes1ak Street j v� Tracy,California Lodi, I&-, - pd►- Manteca, California California Stockton,California F.P.CII.