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FOR OFFICE USE: -Z r lS Permit No. 2_---- • APPLICATION FOR SANITATION PERMIT ---------------------------------------------------- (Complete in Duplicate) Date Issued ,T W - - ------- ---,--.----- This Permit Expires 1 Year From Date Issued Appi 6844ipn is hereby made to the San Joaquin Local Health District for permit to construct and install the wor irein described. This application is made in compliance w/itthh C�Jounttty'OrdinancekN549. k JO f ` ? f B ADDRESS AND LOCATION. �L.:{?C . ------- 1j S P7/4 � Phone •-•.7.1 Owner's Name----------- �J11 ------ � I Address-_-•---------------• i ------------ -- = - Contractor's Name------------------- ---- •- --- ........ .. ��{f'��-5-+-�-�- ��K Installation will serve: Residen Apartment House F1 Commercial E] Trailer Court E] Motel El Other 0 S 0 P Number of living units: ---- Number of bedrooms -------- Number of baths -------- Lot size -----_�1�----1�.4—Ax --------------•------- Water Supply: Public system ❑ Community system ❑ Private'g Depth to Water Table -60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ig Hardpan ❑ Previous Application Made: (If yes,date------------------ -1 No New Construction: Yes 0 No Ok, FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public fewer is available within 200 feet.) Septic Tank: Distance from nearest well-100-----Dista e from foundation---lL�.__------.Material.__ n_.p_________- No. of compartments---- /----------------Size_ _ ---------------:--•Liquid depth--,. -f�.______.--Capacity-�iS�fJ / !_, r /s ` Disposal Field: Distance from nearest well. from founclatio .--l-AZ�._--Distance to nearest lot linejr .___�....- Number of lines----r.-Q-_ - -------Length of each line...._--- tf--- Width of trent>7__ 4 '---------- ------- d --- Type of fi{ter material--IF - -_____Depth of filter material----- length----------C7,10-.----------•------- -- �< Seepage Pit: Distance to nearest well-.- pQ__... Distance from1 f�undation__ _ ._._..Distance to nearest lot line_.___.__.._ 91 Number of pits'��l.C.�l)_..Lining material---"- - 7--Size: Diameter.-3.3_"__...__.Depth__.-c a Cesspool: Distance from nearest well_---------------Distance from foundation--- ----------------Lining material-------------..----___--..---_--.-_-. Q ❑ Size: Diameter--------------------------------------Depth-------------- ------------------ - ---------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------.------------.-.--------Distance from nearest building-------.---------------------------------- 0 -- .-----.---__-----..---_-----.❑ Distance to nearest lot line --------------------------------- ------------ ------- - ------------ -------- -------- -- ---------------- - - - Re odelin 6n /or repairing I(describe).�-_- ----------- -------- -------------- - ----- - ---------------------- �- --------------- ----�` t' ----- ---------- - ks , �.tis ------ ---------- - --------- -----.----------------------------------- --------------- N�s_: ______ ::..:.: ::..::: .. - s I hereby certify that l ha repared this ap lication and +hat t e work ill lle done in accordance with San Joaquin County ordinances, State laws, and r les and regwulatio of the San jqu* Local Health District. (Signed} --- R and/or Contractor) 1. _ . .(Owner ------------------------------- By---------------------------------- --- ...( Q�Q {Title} -- -- ------------------------- (Plot plan, showing size of lot, location of system in relation tuildings, etc., can be place on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------ - -------------------------------- DATE J �. . -- DATE-------- --------------------------------------------------- f REVIEWED BY------------------------------------------------ ------ ---------- ------------------------------------- ------------------ PERMITISSUED------------------------------------------------- ------------•--------------- -------- DATE-------- Alterations and/or recommendations•__..-- ----- - - `�` �� ------------------------- --•------ -- ----- - ---. ----- ------------------------------------------------------- -�' /� ------------ ---------------------------------- ------ ------ ------------- ----------------------------------- ---------------------------- FINAL INSPECTION BY--------------------- Date---------------- .......... --------- ------------------------- SAN ------ -----.SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f F.P.CO. T_ i ..