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"'` FOR OFFICE USE: �} -------------- ---=------- ------------ - ------------- � d . APPLICATION FOR SANITATION PERMIT . .i ; Permit No. ------------------------ --------�-- --- - - f ---- ------ - Complete in Duplicate) - - ---- --- ------ ------- ( - . Date Issued ----TT-------- -�� This Permit Expiiies 1 Year From 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 isMmade_inn,cortp�,Fi� e with County Ordinance No 549. JOB ADDRE AND LOCATE-'�1.I � 1=> ►? }. � o f 5-------------- ,�` ------ -- - - ------ ------------::...... --------------------- 7 _ Owner's Name ` - Pho�nle___.____ r}�, .dl Contractor's Name-------- /� -----------------------------' Fr{ --- Installation will serve: Residence Apartment House ❑ Commercia ❑ Trailer Court E] Motel E] Other E] Number of living units: ---f--- Number of bedrooms -7---Number of baths ---/_ Lot size _________ X21--------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table .2s---ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam � Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes • to ❑ FHA/VA: Yes 2—�No ❑ t 1 TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic,tan k,or_cesspool_per.mittedif_public_sewer-is_availableTwithin,200.feet.) r ,' Septic nk: Distance from nearest wel :Distance from foundation__ ___.___ _. Material__CAN— KE-F -------- ---- No. of compartments______ Size__�X/d___X_ Liquid depth_ , Capacity-j2_00--i Disposal Field: Distance from nearest wel4----S-_t�...Distance from foundation___f ----------Distance to nearest lot line----------------- Number of lines--------------2—__ ---------------Length'of each line-----6-Q-----------------Width of trench----------- - -- -------------- Type of filter material.__T1-,_0_C_K----Depth of filter tnaterial-----V_ ------------ otal length---------/ e;;---.1--------- 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-----------------------________.__.____._. Distanceto nearest lot line- - -------------------------------------------------------------- ------------------------------------------------------------------------- ------------- emodelin and/or repairing describe -- -------------------------------------------------------------------------•=---------------•-------------------------- t - ------ -------------------------- x -- r Y .r .. sF ------------- -------- ------ f I hereby certify that I have 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] ---- -� -- ----------------------------- ---------- • ----- -----.(Owner and/or..Contracto +- ��.. .�By-------------------- - --- --- - -------------- --- -- ----------------------- {Title �r t - (Plot plan, showing size'of lot, location of system i relation to wells, buildings,etc., can 6e pplaced"on reverse side). i`' FOR DEPARTMENT USE ONLY (a ' REVIEWED' BY--------------------------------------------------- - ----------------- DATE---- ' APPLICATION ACCEPTED BY------- - ----------- ------ . DA ----- --------- ---- ------ ---11i BUILDINGPERMIT ISSUED----- --------------=------ ---------------------------------------------------------------------- DATE----------- -------------------:--------- s Alterations and/or recommendations:---------- ------ - ----------------- ----------•------------------------------------------------------------------------- -- ---t. , � -------- ---------- -------------------- ---------------------------------------= ---------------------------------- -- -- -------------•--- Z } __________________________________________________ r______-.____..._. - -- j - Date------------ _._ FINAL INSPLCTION --- . ;_--- - -.- - ---- -�` -� ' SAN JOAQUIN LOCAL HEALTH DISTRICT f 1401 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l Stockton,California Lodi,California Manteca,California Tracy,'California ; k` - F.P.C 9, 1 �.; r >,,}a. - -� .. _� 'ria- en..•.A•� .