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m;vrri�.t ubt:. = . �1�-C.•LLQ M1 ("` - ----------- `--- APPLICATION FOR SANITATION PERMIT Permit No. F ____.___4. (Complete in Duplicate) ----- - This Permit Ex fres ] 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-1R ------ Owner's NameFrx_�.' ._...__r' r-------- ---------- - Address V ---- Phone__ ._6„�-9 d-��S¢-A-- k ----- --- -----------------------------------•----------------------•-----------------•------ -- Contractor's Name------ ` --------------------- -- ------------ 7- A----------- ---------------------------- Phone-- Installation will serve: Residence ❑ Apartment House 0 Commerciale0-- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �-___ Number of bedrooms __�._ Number of baths __/____ Lot size ----- ------------------------- Water Supply: Public system E] Community system ❑ Private ❑ Depth to Water Table i ' t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe E- Hardpan ❑ Previous Application Made: (If yes; ate____________________) No ®- New Construction; Yes ❑ No [] FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: U [No septic tank or cesspool permitted.if-pu6iic sewer is available within_200 feat. Septic Tank: Distance from nearest well________________Distance from foundation_._-______________.lvlaterial_-.______._-_________-_ No. of compartments---__ --__ ------------------------- ---Size--------------------------------Liquid depth--------------------------Capacity--•--------•----------- Disposal Field: Distance from nearest well-_/-4�!_Y--Distance from foundaticn.___!.cl__---------Distance to nearest lot line_3�_r___-• Number of cines__ -__L_�__j____________-_--Length of each line--------,1.4______-_-_-__Width of trench___.___ i Type of filter material_-__-F_vc.-A------Depth of filter material-----fY--"_------__Total length-___„20__/_._--•-_---- Seepage Pit':- -"Distance to nearest,Wei l._IYN" _:.-r-Distance-from'foundation__/A__f--------Distance to nearest lot line__e �- Q- Number ofpits" ' l - ; Lining material__. o�-<( ----.Size: Diameter-- rr Depth- _...�_J esspool: Qi tante fc•om nearest well -_____.-- -___ Distance from foundation____________________Lining material_-_.._.___._________.__-_-____ ❑ Size: T}rerpeter._.=. -- -- _Depths ` --- _Liquid Capacity gals. Privy: Distancfrorn neare`sf_v<ell- �_ -- - _ -_.-Distance from nearest buildin -- - --- ❑ Qistance to.nearest lot line --- ---- -- '� g----- ------------------------ ----- -- � - -------------------- - ---I----------- Remodeling and/or repairing describe .... y --- �------------- ------------------------ - ------------------ ---------------- 1 -- ----- ----------------------------------------- -----__ ;7 --- --- - ----- - -- - =------------------------ ------------------------------------------------" - --------------------- ------------------------..---- I hereby certify flat I have prepared this application'arld_thaf'the work i4il-be done in accordance with San Joaquin County I- ordinances, State laws,'and rules and'regulations of th_. San Joaquin Local Health District. (Signed--------------- D ' ' ----------------[Owner and/or Contractor By------------ P + ---Q --- ---------------- ---------)Title)------ ------------ _______ of plan, showing size;of lot, locationsof system in relation to wells, buildings, etc., can be placed on reverse side. i ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________- "--___,_ ----------I- ---- ------------------------- DATE__ .� `' enJ— ----------------------------------------- -------------------- --- DATE- ----- ------`------ BUILDING PERMIT ISSUED-- --------------------------- ------------ ---------------- =--- DATE----- - Alterations and/or recommendafions:_-__ -_-:q- --�_ �......_..;r -- ' - --------------------------------- - -------------- ------ -------- ------------------ -------------------------- --- FINAL�IN i SPECTION BY- `C-Y �� -• D � -----------------------------ate--- ------ SAN`JOAQUIN LOCAL HEALTH DISTRICT 1601 E.-ffa:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9t6 Street Stockton,California r Lodi, California Manteca,California ! Tracy, California F`.P.CC.