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` /1SJLh APPLICATION FOR 'SANITATION PERMIT Permit No./J.� � . 'm--- Com lets ill 04-0 licafe) ------------------------ This Permit Expires I Year From Date Issued Date Issued 1� 3__ Application is hereby made to the-San Joaquin Local Health District.for a permit to construct and inFss�all � herein described. This application is made in compliance with County Ordinance No. 549. th Sri JOB ADDRESS AND LOCATION ------------- , '( `" Owner's Name----- fJ7, __'' ��,� ��rl/ T.�-(= Address JR �E� �a--- ` Contractor's Name. - y _ ------------------- --- t ----------- ------ Phone.- Installation will serve: Residence I � ❑ Apartment House ❑k-Commer ial� � ti ® •.Trailer Court ❑ Motel [] Other ❑ Number of living units: - _._.Nurjiber of bedrooms _.__---- Number of baths -_"--._- Lot.size _---- p p .�' (� ..,•h..a._ c cR. 1'^'' --------------- Water Supply: Public system A " y ommunity system ❑ Private ❑ Depth to Wafer Table ._ ft. Character of sail to a,depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,® ..Clay Adobe [ ] Hardpan ❑ Previous Applicafion,Made: [if yes,date-,...... r------- No ® New Construction: Yes �No❑" FHANA: Yes El" No TYPE OF INSTALLATION ANA SPECIFICATIONS: 1. SIN w ` {No septic Tank or cesspool permitted if public sewer is available within 200'feet ; Septic Tank: Distance from ne rest well-- 7�---Distance-from foundat.i_on I No. of comp artmenfs----- -f ize--- ' -* >? ' .. } P - -.. - Size -- -Liquid depth----�--- --- --- Ca acit Disposal Field: Distance from nearest well -.--` _."_.Distance from foundatiori -._-_-_-- --_ �� --.Distance to nearest lot line---- Number of lines_---- FJ �' e ----•---- L''ength of each line__/Dc?-__. -_---Width o trench. Type ofifilter material___S. �i J I �O�-.�'----Depth of Pilfer material_ �L-1�`~.----------Totali(f�ngth------��-- ---------J---�--. '� _�Distancelfr m foundation_ _---_Distance to nearest lot line______ _______ Seepage Pit: Niumbe�fin+crest well___________ __ `� -�',�_�# 1�_P 9P Lining aterial '...SizeOiamefer.� `� pe iit Cesspool Distance from nearesfi well--------- -----Oistance from foundation----"------_- -_-_ LiningF``material--_--. ----- ---El +' , P { ------------Liquid Capacity. --------------------------gals. 5iie: Diameter-.-.. ------ De th_-'--- �-- `-`I ... Privy: Distance from nearest well__-. __.----------- _-="-•-------_ -- e from nearest building =_ ❑ Distance to nearest lot line-------------- -P -^ .� Distant; g__"-----,.-- : ------- - --------------------------------- ------------ � - Remodeling and/or repairing (describe):-----.-./!1�- _ f --------------------------------------------------------------- +----- ---- ----- --- ---- ------ ---------- I ------ -------- ---------------------- y� ----- I IT Y Y prepared this a licatiotl and that the work will ib - - - accordance n _---"---.__-."--nty ------------------------------------------------------------------ ------------ -- - ---- hereb certify that I have � ;� - -- -- - ---- -•- - - ----------- ordinances, State laws, and-rules and regulations of the San Joaquin Local HealthDistrict. acco(dance with San Joaquin County (Signed)----------------- t f =a (Title) --. -.Owner and/or Contractor) -------------------- Plot Ian, showing size of lot, Ftlan to wells, buildings,d n s Title By: � ,�... ( plan, 9 location'of ysfem in relab g etc., can be laced I p f ton reverse side). DEPARTMENT-USE ONLY - I APPLICATION ACCEPTED BY------- --� ------ ----------------------------------------------- REVIEWED BY �� DATE--f l - --_- DATE---------- { Alterations and/or recommendations:. :, °� :, b ------••----- ----- ---------------- --------------- BUILDING PERMIT ISSUED 1-i-- rr-,0.4', _ -------- ------------- --- - ---- -- ---------- and/or St � ----- `-=---- ------------- ---------- -------- DATE � r . --. - = _ 4 -- , - - - . k ------------------------ �-- _r -------- vI- ----•--' E�- --- -�- -- ----- -------- s FINAL INSPECTION BY:----....._ _ i --`--l` Date C�' --------- --------- ----------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California