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�rvx vrri�_t u5t: ------------------ - ------------------ ---------------- -------------- -----------------------._.._..__..______ ___.__.___._______. APPLICATION FOR SANITATION PERMIT Permit No- __4Zaa � ------ (Complete in 6UP1.14 IM --..---- •- -- This Permit Ex ires 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. Thislapplication is made in compliance with County Ordinance No. 549. } JOB ADDRESS AND LOCATION_..______ _rw_ r n -------- Owner's . _ . -- , - Name_.- Phone �K.11/�� ----------------- -------•-----------------•-- - ---- --------------- ------ Address----------/ 1_0 (/!! i1 4i_�.-,/.11 J'------ Contractor's Name -- ------. Phone--------------- { Instahllation will serve: Residence Apartment House ❑ Commercial Trailer Court Mo# I ❑ ❑ .t e ❑ Other ❑ Number of living units:----l_ Number of bedrooms _Y Number aths t__�__ Lot size :__ 1t' / Water Supply: Public system'❑ Community system E] Private Depth to Water Tabrle ff. Cha`acter of soil to a depth of 3 feet: Sand ❑ Gravel [ISa, dy.Loam Clay Loam� Clay E] Adobe � Hardpan C]le'� I. Previous Application Made: (If yes, _._ __y 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.) r r i Septic Tank: Distance from nearest well--_YA -_: istanceg-from foundatio'n:-___jr4--------:MateriaLf____- - -_ _ No. of compartments----------7—_.._..-_--Size-----LtF__ _ _ __---Liquid depth l------- � ---------,-Capacity----- -- --------- -- E ! r ! , os leld: Distance from nearest weal_ -L?__-.._Distance from foundation____ �D�i }ante to nearest log Gne_-______ --------- Number of linesr------------ ----------- Length of each line- -- --- Widfih of trench...---- ---•-------- T e of :fi�lfer material_____. 11Depth of filter OW W. length_______.__ �-�j ------- t Seepage Pit: Distance to nearest well-----_----------------Distance from foundation-------------------Distance to nearest lot line-----------------_- ' FT1 Number of:,pits--------------------Lining material------------------_-----Size: Diameter------------------ ----Depfh__------------ ----------- - ------ Cess 11 Distance from nearest well_________________Distance from foundation----- -------_------Lini g material---------------------. l Size: Diameter--------------------------------------Dep#h--------------------------------------- - Il. - - ----- Liquid Capacity------------------ --------gals. Privy:`: Distance from nearest well---------- _ --------------_ -4" ___________________Dis ante from nearest building__ .a Distance t f nearest lot line- ------------ + _____T_-•_F_-_____._ ----- Remodeling and/or r pairi g (describe :_ ____ r p� � --------Q--1------- ---- -- - ------ ti - -------- ----------- ---- ,✓ 4 - ---- - ---- ---- !I� t -- -- - - c } I h ey �y}hat I h ve prer pa his application and that t e work will be done in actor ante with Sart'Jo uin County ordiriances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. Sined ----------- = ------------------------ g ] -------------------------------------------------- ...... and/or Contractor) b By:.--- --------------------------------------•------------------------------------------------------------------------------- -----(Title)----- =� ------------------- ------------- ----- ----------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,w I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----........... DATE-_ -- REVIEWEDBY----------------------------------- --------------------------------------------------------------------------- DATE BUILDING PERMIT. ISSUED------'------------- - D TE--------- --------- - , h� --------- ---------- - - - --- ---- - Alterations and/or recommendations:_-_-_,t'1 ._..Q Q � � - -W- -- I(I �/ r ---- --- ------- 10 r 'f FINAL INSPECTION BY:---- a r Date-- -------------------- i 4 � F SAN JOAQUIN LOCAL'HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 0. li