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rlll[ Vrril_r u7C: ----------------------------------------- ------ v ----- ----------------- --------------------I——-- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ..�.�L.�_ ------------------- -- ------------------------- ---- (Complete in Duplicate) ---------------- ---- -- 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 t e work herein described, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT N---_ IOU Owner s Na l wN. s PhoneW�_A,,_AM.Z Addres - ' ` 11. _s ----------------------------------------------------------------------------------------- Contractor's Name--- -------------------- �-- r t- Phone?-_$Pl Installation will serve: Residence Apartment House ❑q Commercial E] Trailer Court E] Motel El Other Number of living units: I-.____ Number of bedrooms _;!*' Number of hs __ Lot size ----Ace-e g Water Supply: Public system C] Community system E] Private Depth to Water Table _,9._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe ❑ Hardpan [❑ Previous Application Made: (If yes,date..----..--------_) No ElNew Construction: Yes ElNo FHA/VA: Yes J_-] No [ TYPE OF INSTALLATION AND SPECIFICATIONS: - ...� No septic tank or cesspool permitted if public sewer is available within 200 feet.) S t Distance from nearest well- ----------Distance from foundation-------------------Material------------------_---.__...______.____._.__.___- t No. of compartments----------------- --------Size----------------- -------------Liquid dep.th ---------- - ----------Capacity------------------- awells-D.- D o Distance from nearest wells �____Distance from foundaf _+ {�r1____ }''on__ eDistance to nearest lot hf_-_ Number of lines____.___-------------- Length of each line----+# Width of french. _____ i Type of filter materialp g ------------ _De Depth of filter material____-_��(_-______._Total length `1 Seepage Pit: Distance to nearest w _________ Distance from foundation------.------------Distance to nearest lot line__.__.___-____._ ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter--__---__'_---------Depfk--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation_________-_ -Lining material__.-----------------.___.____________. El Size: Diameter-----------------r-=- ------Depth-------- -------------------------------------------Liquid Capacity----------------------------gals. -i Privy: Distance from nearest well-':------------------------------------------____Distance from nearest building.-___..._____-_________________---_---- t ❑ Distance to nearest lot line----------------- ------------- ------------- ----------------------------------------------------------------------------------------------` Remodelingand/or repairing (describe):----------- - ----------------- -------------------------------------------------------------- ---------------------•---------------------------------- -------------------------------•---------------------------------- ------- -- ------------- ----------- --------------- ------------------------------•------------------------------- -------------------------------------------------------------- - fr�+�r --- -------------------------------------------------- --------------------- --- ------------- -- , I hereby certify that I have prepared this application and at the work will a done in accordance with San Joaquin County ordiye ' to ws, and ru rid regulations he San aquin Loc th Distr' t. t (Sign -- tlf ----- -- -- ----- A-- - ---------- - ------ --- ---------- --------- -- --. Contractor) G r ------------------�- - i le) --_--- ............. - ---- ----------------------------------------------------- - ------------- -------- ---- ----------------------- (Plot plan, showing size of lot, location of system in relation to wel , uildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----__-1--4-t.1-()•------------------------------- -------------------------------------- DATE-------_3_7_23-i5 -�------------- REVIEWEDBY------------------------------------- ------------ -------------------------------------------------------------------------- DATE------------------------ BUILDINGPERMIT ISSUED----------------- ----------------------------------------------------------------- ----------------- DATE Alterations and/or recommendations------------------------------- --- ----------- -------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- -------------------------------------------------------- ------ ----------- ------ --- - --------------------------------------- - FINAL INSPEC�1Qd- Q. ----- Date--- ------ ,6—s— SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.CO.