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1 ' FOR OFFICE USE: j , ------------------- ---------- "----- ------------------- ------------------------ -------- ---------------- ------------------ _"_________________--"u-----.-_----__._______-- APPLICATION FOR SANITATION PERMIT Permit No. _ . .S�I lI (Complete_in--Duplicate) ---------------- ----- ---------------------------------- ------ This Permit Ex lies i Year From Date issued Date Issued 15;1____l�a 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 o. 549. ' II `. JOB ADDRESS'AND T! " "" "� ' ^� "'"" - --� Owner's Name'_________ ---- ------------ -© --. ---- ,.?r11 .-- ---- - ---------------------- h � -------- - Phone Address__. -• ----- ---- -_ ------_� ---- --- �--d '•................. Contractor's Name---------------- -- Installation will serve: Reside Apartment House'❑-Co ercial ❑ Trailer Court ❑ Motel ❑ Other Numbel`of living units: _�.----- Number of bedrooms _�____" Number of baths "� Lot size _8.11_�._K__ -�___________________ I Water Supply.,- Public system ❑ Community system ❑ ; Private Depth to Water Table 20- ft. j Character of soil to a depth of 3 feet: Sand Gravel ❑" Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [❑ Previous Application Made: (If yes,date___________________) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No f TYPE�GFANSTAL•LATION AND SPECIFIC—ATIONS: (No septic tank or.cesspool permitted if public sewer is.available..wi.thin.200_feet.)— t r Septic Tank: Distance from nearest well- . -__.,.__-Distance from foundation_..10..._.......Material__ No. of compartmonts___ ..------------ -------Size__ ..K_-_`�---------------Liquid depth--S-X-f'---------- ---- _ _- r Disposal Field-1 Distance from nearest well---.,W.!_�Distanc fromy�ou ior<.,i�0 ---..Distance to nearest lot line___`._...... l Number of lines-_t(t�1_..---_._. __ Len P f ech Ilan .. _ - << g' a° -a� Width of trench__ Type of filter material__�_`Depth of filter material_.__�-%_!i- ----Total length-_- :--"---1 _�__ U Seepage Pit: �" Distance to nearest well ----- 10 from foundation----_________!---- Distance to nearest lot lin ----------------- F1 ---_------_---- # ' t r + ( 0 ❑ Dumber of pits Lining material Size: Diameter.---•------------- --- Depth s Cesspool: Distance from nearest well------------- Distance `from foundation______------_.e_-._.Lining material---._-.___-"_..-_--.--____---:--_-_-._ -1 ' ^�"�❑�- Size ia`meter De thT �r-� — = . ..Li uid�Cep iiY gals. r� p ------` T i. �, 1 Distance from,�nearest well ------------------------- -Distance from nearest building_ .____----..--------------------------- Privy: ❑ Distance to nearest lot lin ------------------------------- ------ ---------------------------,------------•--------------"-------------------•- ' G r -- -d/or repair;n _'(d r'be):- �1 ' - err'' _ Remodeling ari. v ------- - - t a -------------- - -- ------------ l ; t . --------- ------------------------------------------- ------ - ----------- -------------------------------------------------------------------------------------------------------------------------------- I hereby cerk � repared this application an`d"that fhe work will be done in accordance with San Joaquin County ordinances i ej laws,'and,rul a"nd regulations`,of,the San�*Joaquin Local Health District. + (Signed -----------------1----- = - �' s --- ---------- ------ ;} _ -------- and/or Contractor) � � r � `� BY� ---- ------ -------- = = = z; ---------------(Title)----- (Plot plan, showing o _lot, location of system insrelation t`o�wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONl-ACCEPTED BY ., 4± ty DATE 1 ---------------------- REVIEWED BY _ _ - t -- -------- ------------------------- ----------------•---------DATE-- BUILDING PERMIT ISSUED------------------- }` ------------------------- Alterations - DATE------------------------- ------•---------------- -- Alterations and/or recommendations-------------------------------------- -- -----"---- ----------------------•--------------------- ------"--------------------------------------------------------------------------------------------------- ----------------------------- ------- ------ --- -•---•- FINAL INSPEC Date _-� - �---------- - ----------------- E SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 6,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street II Stockton,California Lodi,California Manteca,California Tracy,California to 3 F.F.0 u.