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VUR UFFICE USE: ^ ------ - --4 --- ------------------- - � //.'-.�_oAPPLICATION FOR SANITATION PERMIT Permit No. ...� �� ' . --------- - ------- -- ------------- {Complefe in Duplicate) ------ - ------- � This Permit Expires 1 Year From Date Issued Date Issued t 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 LOCATIO --- __ ----lam>r Owner's Name----- a �- ___ _, ..,fes , - � :-_- - -•--- -------- ---------- Phone-.----------•----- Addressu1 ?�i �'`. � - -----------------------------•- ------...------------•----------------------- Contractor's Name------------ " - - -��-------------•---------------------------- ----------------------------------------------- Phone----------------------------------- Installation will serve: Re idence [e---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other E] e 1 Number of living units: _1Number of laths -/ .-- Number of bedrooms f,�fJ' ,-_._ Lot size Water Supply: Public system [ Ct ommunity system Private ❑ Depth to Wafer Table f4-ft'. Character of soil to a depth of 3 feet: Sand ❑Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Ll-'nardpan ❑ Previous Application Made:(I-f yes+da#e` j�`No '' ®/'New Construction Yes - Ro ❑ FHA/VA: Yes ❑ No K]-• y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----`�------Distance fFm foundation---49- --- ------.Mater ----------- �i ®� No. of compart lents Size- '<__o---------Liquid depth----- --------- Capacity-Z!5_14 --.--• Disposal Field: Distance from n4e resf well----- -----._Distance from foundation__Z�_'_--Distance to nearest lot line__-_-�.--_. Number of lines-_----�.------ -.- - Length of each line___r_P... .! Width of trench.,.?---f-__-- e �j ------------------- Type of filter material- /�- -Depth of filter material---__ ,i ___--.-Total length-_--n -- -------------------------- Seepage Pit: Distance to nearest well_ ----.` --:----- _Distance fr m fou dafion --_-07-`_Distance `.Distaf ce to nearest lot ( Number of pits_)_;__ /------------Lining material-- Q -size: Diameter: r , Depthaj -.-/ f�X- Cesspool: Distance from nearest well---------------- Distance from foundation---.-_-.__.__----.Lining material---.__-.----_-----------_------------ ❑ Size: Diameter-I:I---------------------------------- Depth- Liquid Capacity gals. Privy: Distance from nearest well------------------ ----_-----.-- --------Distance from nearest building ----------------- ❑ Distance to neatest lot line Remodeling and/or repairing describe :... _----.-'-- -r '4 4-4*4 ---------------•-----------------------------------------•--- ----------- --------------------- - t---- -----• -- --- ----- I hereby certify that I have prepared this appfica—fin nd—tha+the work w IIYbe done in acct orlon ee with San Joaquin Count ordinances, State laws, and rules andVaeulations of the San Joaquin Local Health District. +'p (Signed) '�'d� / -------------- ------ ----- ---- --------- ------- j�or Contractor) By:--------------------------------------------- --------------------------------- - Title (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). r ,{7!� �o FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----- C_`_7---------------- ------ --------------------------------------------------------- DATE----- --- RE�EWED BY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED---------- -•--• --------------------------------------------•--------------------------------------- DATE Alterations and/or recommendations:.--_�:�1 -foe------- '�'a_hs- �1---— ��_ l�+ p - ------------c,-- ------------- ----------------------------------------------- ---------------------- -------------------------------------- - .- --- �'--- •----------------•-------- FINAL INSPECTION BY: SAN,;JOAQUIN LOCAL.HEALTH-DISTRICT 1601 E.Haxelton Ave. 300 West ciak,street' '�' 24 Sycamore street 205 Wes!9th Street Stockton,California Lodi,California Manteca,California: F Tracy,California F.P.QU. -