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----------Y.---------- --------------- ----- -------- ------ ------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------- (Complete in Duplicate) --------------- ----- -- - This Permit x fres T Year From Date Issued - Eae date Issued 1/77�------------- Application is hereby made to the San Joaquin Local Health District for a permitf to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �h JOB ADDRESS AND LOCATION____ --------------- -------- --------------------------------------- --- •--------F--"--'-�- ---- -------- Phone-_— _ f -------I---Z-----.�-P------- - Owner's Name Address 1- ------------ Contractor's Name--- - ----- ---- Installation will serve: Residen [ Apart nt House ❑ Commercial ❑ Traile� Court ❑ Motel ❑ Other ❑ Number of living units. ___/__- Number of bedrooms __ rr �/ _ Number of baths __-J mot size __ - Water Supply: Public system �/ �' - --- --�--------••--------- ----------------- PPY� y ❑ Community system Y- Private ❑ Depth to Water Table ---<- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamClayK Adobe Q Hardpan ❑ Previous Application Made: {If yes,date------- _-----_----I No a--New Construction: Yes No ❑ FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: '" No septic tank or cesspool permitted if public :ewer is'available-within'200 feet.) Septic Tank: Distance from nearest well_Xr4l%-__Dista ' frq f undaiion_--/--U_.---_-- Mater al-_ " ___. 1 No. of compartments_.- _ --__---_Size- ______ -_-_ ' 1 --� -_Liquid depth ' - Capacity--------t_ Disposal Field: Distance from neatest well-100.0-Distance from found tiQn.2y7 'r Number of lines-----;' f �, I -- istance to nearest lot line __ Len Length of ea �c�S c� c �r ------- ------- g ch`line- ------- Typer icth of french `l� .. of filter material✓_515't - Depth of filter maferial-__!._ _ ---_._-Total len th_____,- _ ------------------ --------- ___________ Seepage Pit: Distance to nearest well__ ___---__Distance from foundation______._________. g � �� Distance fo nearest lot ________ __ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------- - ----Depth--- --------------------- --- ---- --------- - Cesspool: Distance from nearest well__-_______-__-__Distance from foundation--.-- "--_----__---Lining material--._.-_-_--"---_---- "--__- ❑ Size: Diameter--------- ----------------- - -------Depth-------------------- ------ -------•- Privy: - . ----•-Liquid Capacity------------------------- -gals. Y� Dista rice _____Distance from nearest buildin ❑ Distance to nearest lot line- -- ------ 9 -------------------- --------------------------- Remodeling and/or repairing (describe):___-_.- --- ------- -- ----------------------------------------------------------------------•-------------------------------------------------- ------ ----------------------------- ------------------------- - ----------------------------------------------------------- - - _ ----- ------ - -- 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. /y,j (Signed) -------�---- -- - -, t�.vi�� G(3 /� ------1 /��e� Ci ! _ ` - 1 ----- - ----------------------- _ _ whet BY----------�---------�--------------}--YT .�` -- - -- ------- - and/or Contractor) ------ -- -------------------------------------------------------------- - - Pot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pi ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------------- --------------------------------------- ----------- DATE.-----•- REVIEWED BY ----------------------------- --------------------- ----------------- DATE / `- F BUILDING PERMIT ISSUED �f ~ —t� - \, ----- v Alterations and/or recommendations___________________"-__- f $ATE -"__-.__..__--___ " -------------------- ----------•----------------------------------------- ------------------ ------------- ----------------- ........ ----------------- --------- ------------ ------------- ------------ ------------ - FINAL INSPECTION BY----------------------- " - ` U� Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haserfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi,California Manteca,California Tracy,California 0