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----------- ----------- ------------------ -------------------------- APPLICATIONFOR SANITATION PERMIT Permit No. .��_�1 --------- --------- -------------------- (Complete in Duplicate) ""---""-- ------------------------------- ------ This Permit Ex ices 1 Year From Date Issued Date issued ��ll__-4" 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,w#h County Ordinance No. 549. 3 ic% ®f! - f70--03 JOB ADDRESS AND LOCAT ON: _6 i Owners Nam e_______- Address C� : ----------------------------------------- Phone-------- ----------- - .._.eL_._._! y f - --- nContractor's Name- _ _ _ --- --•---- ` Installation will serve: Residence ] Apartmen5etdg " Pho ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units:�------ Number of bedrooms -Ak_ Number of baths __.1- Lot size Water Supply: Public s � �� ------------------------------ PPY� stem y ❑ Community system ❑ Private LP Depth to Water Table r_ ft. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Cla10y Y Y ❑ y ❑ Adobe ❑ Hardpan ❑ r-�- Previous Application Made: (If yes,date--------------_---) No ❑- New Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No_septicrtank or cesspool.,permitted�f;public sewer is available within 200 feet.) .Septic Tank: Distance from nearest well__c��'_ -"" ' ---Distance from foundation-- -----------Materiai__ ------------------- No. of compartments__A-__.__..------- Size 2- - -- -----------Liquid depth ---� -- Disposal Field: Distance from nearest wellv$�a`Y.-__Distance from foundation___.�,Q___._.__"--Distance to nearest lot line-A-0.'."""". t* FE Number of lines-----/------ -----------------Length of each line_----1G.Q____...___..- Width of trench. ,�.-[�-'------ "1 Type of filter material��----_-_----_Depth of filter material_ �� / ---- _-_-.-Total length./*-_U------------------------------ Seepage Pit: Distance to nearest well_---------------------Distance from foundation---__--------------_Distance to nearest lot line--------- ❑ Number of pits---------------------Lining material------------- ------.Size: Diameter-------------. Depth ____ -" ---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------- ____.__- ------------- Size: Diameter-----�-- --------- ---------- ----Depth------- -------------------- -------- - ---------Liquid Capacity- --- ---------------------gals. { Privy: Distance from nearest well---------- ------------_---_---------__----------Distance from nearest building g ❑ Distance to nearest lot line__________________.___-_-""----"_ , Remodeling and/or repairing (describe):_____._.____.____---"_--""-_ # ------------------"•----•--------------------- ----- --------•-----•---------------------------------------------- ------------------------------ - ------------------------ ••-------•--------------------------------------- --------------------- - ---------•------------------"---------------------------------------------------•---------------------------•-------------------------- ----------- ----- 1 herebycer+if '}ha} I have ' Y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. (Signed) — __- - Tand/or caner at or on rac for--- By:------ �� - -- .-- . (Plot plan, showing size of lot, location`of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ - , ,.�, r REVIEWED BY - - ----- ------------------------------------ ----- DATE_6 .�/O- (6 ---- - ----------- -------------------- ------------ ------ DATE------------------------------- ----.----- BUILDING PERMIT ISSUED-------------------=----------- ------------------------- ------------------------- -----------. DATE------ ------------------------- +erations and/or recommendations.___'____.--___.- -- _" ----- --------•-------- ------------------ --------------------------------------- ---- -------------------- ----------------- f--------------------- -- - -----------•----------------•------------ r ------------------------------ i ------I-------------------------------- ----------------------------------- I -------------- - -- FINAL INSPECTION BY:__ 1 T g Datea7-'�-` -''--G- ------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P. D.