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VUK urri(-t ust: 3� `�� - --------------l�,' 7 -------------=--- -------------------------- of -------___ APPLICATION FGR`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 install the work herein described. This application is made in compliance with County�Ordinance No, 549. JOB ADDRESS AND L/.00ATION_.ele_6 --------------------- G l`FF/• - r = te , r r-'�r/l "/� . Owner's Name-----------/-L--�//f 67X Avl /t-t - Phone_:"l Address----- --••--------- Contractor's -----Contractor's Nam ------- ----------- one. Installation will serve: Residence E] 'Apartment House E] Commercial_0+-Traier,Oour# E] Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms____-' `IV_u'mber of�baths --�_-_ Lot size I Water Supply: Public system Community.system r Private ❑ Depth to Water Table -------- ft. i Character of soil to.aa depfth of.3 fee+:� Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [El—'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_--__.- No ❑"New Construction: Yes ❑�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic rik: Distance from nearest we[ -.-__`--- Distance from foundation... Material_____ __________----------------- -- -- ` j_.._-____,-_, No, of compa © rtments Size__ ._____� " ��` X_ Liquid depth *� r�� Capacity__,?n�---f' +� Disposaa,Vield: Distance from nearest well___ " -----Distance from foundation-J,_0 ___-Distance to nearest lot line fZ� _! [] Number of lines--------/---------'--------------Length of each line----- -Width of trench---- ��--------------- Type of filter material,_-- N pEpfih of filter material---Itr f---------Total length-------d,4,__---________________-__ I Saepage.Pit: Distance to nearest,well-.____--�"-__--__Distance fr m :foundation__-_ __ --_Distance tonearestlot line___7_ / , ` Q Number of pits----- -------- --Lining material__ / ' ,.-.Size: �iaiilete�r.2'=R'`r.---- --ppth >_'---1-2 ------__---- r Cesspool: Distance from nearest well-----------------Dis}ance from foundation--------------------Lining material---------__--_---___-_____-_________ ❑ Size: Diameter-- i ----Depth—4.----- `Li uid Ce aci q Pty ---------gals. i -_._.-_Distance from neares} building_ Privy: Distance from nearest well________________________ ❑ Distance to nearest lot line -- ------------------------- Remodeling and/or repairing (describe}i""f r � = * ------ --------------- - " _ ^ .t� ox -------- �...... -------------- ,% ; -----------------•---------------------------------- ------'---- - -•-----------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance:, State laws, and rule egulationsFof4the San Uoa uin cal Health District. -------7i__ t , 4 v (Signed) f �.. t - / --------- ------IOwrter and/or•Contractor, - -- ------------ By:--- ----------- �----------� '-----------I------------------------------------------- Title (Plot plan, showing!size of lot, location ss+em il+ relation twells, buildings�, =can=be placedton reverse side). j FOR DEPART. ENT"f5E ONLY APPLICATION ACCEPTED BY - - - •......!_ r----------------------------- DATE----- 'Z/moi -------------- REVIEWED BY.- t DATE---- - - ----•------------------------ BUILDING PERMIT ISSUED------------ _ , 1 DATE E- s:_ 1 -_ _ r ��----Alterations and/or recommendation - �- ----- --- r-Q------- ----------------------------------------------------------- -=---- -- ----------------- ----------------------------------------------------------- - - ------------------------------------------------------ -- --------------------------------- ------ ----------- ------------- ......' - J FINAL INSPECTION BY:------ - f�� [----------------- -------------- Date_----- - ---Z----------7 �''� -------------------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lad i;.California Manteca,California Tracy,California F.P.0 O.