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rvR urrit,t u6t: _ ------------------------------r-----------�-- --- 0r ------ - - --_-- APPLICATION FOR SANITATION PERMIT Permit ------------------ - ------- ----------- --------------- (Complete in Duplicate) f �' -"---"---_. ---- ____ - This Permit Ex ices 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 compliaricce with County Ordinance No. 549. F t J08 ADDRESS A LOCATION/ _�7.�.1�_ �of. dre: Ac ' -- �_�� : Owner's Name------- --------- _ -------------------------•----------------- - . Address 7 � Phone -------t--------------- Contractor's Name"----- --------- ,ra/ Fr ] ------ -------- -- --- ---------- Phone..-...--. installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of living units: __.f Number of bedrooms - .- Number of baths -xr - Lot size Water Supply: Public system -------------- ElCommunifiy system-`❑ Private Depth to Wafter Table -7.- ft. k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__________ ______) 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.) Septic ank: Distance from nearest well----JO__l 'Distanceafro foundation-_.--` Material -_ - - -- --- ----- No. of compart Tents---._-. -------------Size r --- -----Capacity----�a?� 1 ..-/1��"-A`--��------•'liquid depth--------�-- - - Disp_ossal Field: Distance from nearest well--_-..5 Distance from foundation_-___P------.--Distance to nearest lot line__--� LJ Number of lines-I---------�------------- Length of-each line---------/�a ' , gi� - ------------------- _t---- lengfih-"---..r��4_'---__ V. - Seepage Pit: Distance to nearest well--__"--,_--- =,bistance from foundation___--- -_--__-.-_-.Distance to nearest lot line--------------- -- ❑ Number of pits--- -----------------Lining material----------._-------_-_Size: Diameter----------------------Depth 1 _-- 3 T-�. - _ ,y -..�- -_.�__w esspool: Distance from nearest well--------------._-Distance from foundation--- ----------------Lining material--___.-_-------------- ❑ Size: Diameter-_-i-.__"-_ ------- --=--^,'.,.`depth_-"._.�.�----==�-=-�-= -"-�------ -m�--------- Liquid Capacity- -------------------------------- 1f ---gals Privy: Distance from nerest well---------------_------------- --- ------- from nearest building El Distance to nearest lot True___--------------------------- Remodeling and/or repairing [describe]:-------------------------------------------------------------------- ---------------------------------------------------- t ---- ------------------------- - --------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statflas, d rules and regulations of the San Joaquin Local Health District. (Signed)---------- -- -- # nd/o------- - ----------------------------------------------------------- ------•------------------ r Contractor) Plot Ian, showing size of lot, t- Title _ _ •_--- Q- --___-"-•---y- "---___ ""_-_- P g locations of system in rela on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �j !l �y �ir�e ---- ----------------------------------------------- DATE--- 7 "REVIEWED BY ' BUILDING PERMIT ISSUED- ------- ---------- DATE---------- - --------•------------------------------ ----------------- - -- • ---- -------- - --------�-- --•--------------------------------------- DATE------------------------ Alterations and/or recommendations:-._.--- -------------------- ------------------ ----- FINAL INSPECTION Date j� ��b ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.CO. a