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t-UKUt-NU ------------------------------- - ----------------------------.- ----____--- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ------• ---- ------------ ----------- ------ ---- {Complete in Duplicate} _. -------------------`---------------- ------ This Permit Expires 1 Year From Date Issued Date Issued ---- Application is-hereby made to the San Joaquin Local Health District for a permit to construct and instal thew rk herein described. his.appli�a;tion..is.made:in,compliance with County Ordinance No. 549. le-W .i YE--(otoo JOB ADDRESS AND LOCATION_ .-__Q{1�1 --------- ---------:------- � Owner' Pa s Name-.-----_- (,L_-•---• C� Lig j - iv ------ Phone._ A. -3_�_ l �_ k Address-. ) �- �.�..'.fr� x -------- Contractor's Name...... --••---- -------- Phone----------------------------------- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel El Other Number of living units: ---�-- Number of bedrooms _-'3_ Number of baths -__---. Lot size __--._-� Water Supply: Public system E] Corrimun"it s tem Private Depth to Water Table ZO ft. Character of soil to aof 3 feet: kand i'�. "` w i1 depth. Gravel ❑ Sa dy, Loam ❑ Clay Loam ❑ .Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date_-- _-_--_ �' r �4sa . # } No New Construction: Yes .�o El ia-FHA/VA: Yes ®t.No TYPE OF I_NSTALL{ATION AND rSPECIFICATIONS:_ Ir ,1C t �: _.._;., �- <;A - .� _. �•ter .4. {No septic t nk rices pool�permtt$ed if public sewer is ava;lable:within 200 feet.] � .� , . Septic nk: Distanceffrom nearest well_---�,2._-----_-Dis#ante from foundation---. 1°f'Ui�� No of compartments-------"!' __- $ize X r X �� - Liquid th M/ f_" _.- Capacity ri I a q P Capacity--ems L� Disponi Field: Distance�frominearest well ____Distance from foundation... line 1� - .1 ----...-.Distance to nearest lot �__ Number of�lines`1_---------f-------- -----------Length of each line---- 7_�-�_-- Width of trench-_.- .2 Type of filter matenal-S_.-_l Q_C C Depth of filter material--.---/__9______--..Total length----_---12�� C ' .. t '•------•-- m $eepa a Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___f`:----__-._ ❑ Nimber of pits-- -______-_.---_-__Lining material-_.----_-- _ ' c" Size: Diameter -------------- -=Depth----------------...- ------ r : Diameter----=- ------ - -------------------Depth-------------------°-------- Liquid Capacity - £ essp ol: Dz'tance from nearest well Elifrom foundation.-..-.--_-------_.-.Linin material.---._----------.-_----------------- t --.__-__.. __-. Privy, } I- . �` - -------gals. Priv Distance from nearest well----------------- _-----_.._---_._---Distance from nearest building_ ., g ?-'�'�------- ❑' Distance to nearest lot line Remod eling and/or repairing (describe----------------- ---------------------- #•-----••----- •------------•=-•---------•-------- ----•------------------ ----------------•------------------------------------•----------------•--------•-------------------------••-------- --------------•------------------•-------------------------------- 1hereby certify that I have pregared this'application and that the work will be done in accordance with San Joaquin County ordinnces, State laws, and rules and regula+;ons of the San Joaquin Local Health District. Si ned}_-__-- -�•�� --�-- - __. r>= -�•- .._ - _ ,, _ (Owner and/or Contractor) BY:---------------------------------=------------" •-- ---- -- �r --- ------ +IQ]--------------------------_-- -- :-��- (Plot 4 n; showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side) I FOR DEPARTMENT USE ONLY (r d ? -�- APPLICATION ACCEPTED BY .r. Rev . ----- -- --- DATE---------f .- �- REVIEWED BY. ---------- --------•---------- ------------- DATE...--------- -.,_. ..----••-- BUILDING PERMIT.ISSUED----------------- --------------------------- DATE- ------- - Alterations and/or recommendations:x---------- ------ ------------------------=--=------......_----•----------•------ ...............------------------------------------------- -- s -- rr-- -----�AtJK------o.X_..------5_--2g-� Tx --- -o- ------- ------ ..... •- -- -------------- ------------- - - FINAL INSTiN.BX i �--- Date------e-3, -- T ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wes!9th street Stockton,California Lodi,California Manteca,California Tracy,California ca-9 PrVI9E0 8.59 E.P.Co.2M 6-60 /: