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FOR OFFICE USE: � - ----------; APPLlCAT10N FOR SANITATION PERMITPermit No. _----------------------------------- ------ , (Complete in Duplicate) Date Issued __-_----.:_.-__ This Permit Expires 1 Year From Date Issue Application,is_hereb made.to.the San Joaquin-Local Health District for a permit to construct and install the work herein described. Y1 - _�,.� I This application is made in compliance with" County Ordinance No. 549 � JGB,ADDRESS.A--N--D---.L-O---CA--T-I-ON. _ Owner's Name---- -------c �•; 1----------� -----------�------- -------------------------------------------- Phone--- - Address ,�'r --------------- --------------- --•-------------- ----------•---- -------------- --- d Contractor's Name---- -----•------ - ---- -- = �1.�°..t Phone--- =:�0 Installation will serve: Residence Apartment House ® Comme ial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numbei of livingunits: _._---- Number of bedrooms -11'Private ber of baths .1_.... Lot size ----�0-----X-1-�•5�J-- ----------- ------------ Wa#er Supply: Publicsyst `� Community system ❑1 ❑t Depth to Water Table - ft. Character of soil to a e +h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ] Clay Loam ❑ Clay ❑ Adobe$I Hardpan ❑ Chara a ll p Previous Appli6 ation Made: [if_yes,date--.._._- .......I iNo$ENew�Construction: Yes ❑ No ®-- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t {No septic tank}or cesspool permitted if public sewer is available within 200 feet.) 1 I, i Septic Tank: t Distance from nearest well...-_....___--.IDistance from foundation--------------------Material--.--..-_..----.-..----------------------------- Septic __-......____...__._____ -. I. ❑G1�LS4�6 No.'of'Ed mperr me�s� Size-.-- . ---Liquid depth------------------------- Capacity I `I I ,�-.�_- Distance to nearest lot line.......... Disposal Field: Distance from.jnearest well.ANPP7 Distance from foundation._ ----- rr Number of lines!-7z' l�_:__-_-- -- �each`line ��!! . // ..rr -,W..Width of trench_----------------- ---�-/Type of-fil#ergmaterial..__- J.Lengf�o epth of filter m`aate`iYal...1__l�-........... otal length___-. ��-�--------�'/ ---- I I I . Seepage Pit: I Distance to nearest well.....___-_....__... _�Di`stanee from foundation....................Qistance to nearest lot fine_--...__......-.. x materia . t I I p ❑d�K [IIJG � P� nearest-well-------- g-----ateriaL---- --- ----- - -- Size: Diameter------------- ---- ---Depth ----------------------•--- 15�� Dumber of= its.... ._.-...��... _ Linin mDistance from foundafiion____________________Lining material.____.-..-_--...__...-.._---..._._. Cesspool: Distance iia -------- ala. t .Liquid Capacity ❑ Size: Diameter- -----------� ----- ---- --- ept:h.,.�----'°••�'�---k-- �----- - ---- --------- g Privy: Distance from nearest well-...-.__..._----------------------------------Distance from nearest building.____..._-___-.__--_-----.----..-----.---- Distance to nea'rest loft line------------------------------------------ r .. 117 f� 4 --- ------- Remodel' and/o,IC,rfiring (d' __- --------------- ------ ------------------------------- ------- --- ------- f{ _-._-..._._.................... - --------------------------------------------------------- -- - --.... ....... ......................................................................................................................... _._._....--.-.-.-..-.. hereby certify th I hav .prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State law and rul and regu ions of the San Joaquin Local Health District. i Owner and or Contractor i # Xwel�ls, S t--- ----------- (Signed) ----- --------- ----- ------- { / ) - - -- -- ---- - -------------- -------- - ' -----{Title) ........... ----------- ------ By:-------r- ----- ----(Plot plan, showing size of lot, locationof system in relatiouildings, etc., can be place n reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY.-- /} ------------------------- DATE /. '-� r < C/ I REVIEWED BY------------------------- - -- DATE DATE-------- ----------------- ----------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------ ----------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------- ------------- Qate----- ----- ------- SAN -x FINAL INSPECTION BY:. ----- -1Z �.- ------------- - --. SAN 7-----�.. -- ------------ �- JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazollon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California