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FOR OFFICE USE: -------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ........ [Complete in Duplicated --------------------f f� 6 -------------------------------------------------- ------ Date Issued - --__-------•----_--------------------------------M"."- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a to a •ZL- w k . 'n des¢/iloed This application is made in compliance with County Ordii�nance No. 549. JOB ADDRESS AND LOCATION.... �M�,� N• �� I�� ., _'� �'�--Owner's Name----------------------------•.••-•----------------------------------�-r-------••-•------ ------ Phone__�s�__5061-tAddress--------------------------------------------•-:--L]�._ q3D-----St-r--o -no-N-------•-------------------------------------------------------.-,--•----------------------Contractors Name---------------------------------05'[ ---------------------------------------------------------------------------------------- Phone------------•-------•---Installation will serve: Residence [Apartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_._ Number of bedrooms -/ Number of baths _(*___ Lot size ----f•9_,_____________________________-_____-___-__._ Water Supply: Public system ❑ Community system ❑ Private [�- lsepth to Water Table _(26—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam © lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-„_ _.___.----) No ©' New Construction: Yes ❑ No FHA/VA: Yes ❑ No Fl-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'r Sepfic Tank:'Distance from neares -well'-°"°��'-"-Distance fPom foundation-^`----- Material -�---___---'_._—" "-� p' XjS#]fi3(r- No. of compartments_. ------ -_Size---------------------------- -Liquid deP}�)-- ---------. _ Capacity ��.__ Disposal Field: Distance from nearest well-/00------Distance from founclation_��^ ____-_-__J-Distance to nearest lot line`r��_'_!__. Number of lines__.______ ______Length of each line____ 0- 4 0.__--.-.Width of trench--____t _fly----------------- _De Depth of filter material--------- length_._::_ ___ _ G?__f__________________ /�DpE�taNtf go Disp#ance to nearest well � P Type of filter material_ Seep ge -------------------Distance from foundation--------------------Distance to nearest lot line__-___--.--.__--_ ❑ Number of pits----------------------Lining material------ --- - ---------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-------__--------Distance from foundation--------------------Lining material-_____-_--_-_--__________-_-_-_______. Size: Diameter------------------ ------Depth--•--------------------------------- ------------Li u 1 - --- gals. _ Liquid Capacity Privy: Distance from nearest well------------------------------------------------Distance from nearesf building-____--_____------____________________-_. ❑ Distance to nearest lot line------------------------------------ ------------------------------------------------ ----------------------------------I------------ Remodelingand/or repairing (describe):----------------------------------------------------------------------------------•-------------------------------------- ---------------------------- ------------------------------------------------------------------------------------------------- . a ---------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and the+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. c (signed__ _ f'l�_ - '--- +� ----------- ---------- ---- Owner and/or Contractor [Tltle)--------------------------------------------- (P o plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. .... - - - t FOR DEP RTMENT USE ONLY ' APPLICATION ACCEPTED ------ ----- -- -----•------•---- -------------------------------------- DATE--------/7/-�----tt--------- ----------------- REVIEWEDBY---------------- ------- ------- ---------- ------ ------------------------------- -------------------------------- --- DATE------------------------------------------------------------ BUILDINGPERMIT I UED----- ------------------------------- ---------------------•-------------------------------------• DATE------------------------------ ----------------------------•- Alterations and/or r o ndations: - ----- - ---------- -------------------------------------------------------- ------------------------------------------------I-------------------------------------------- ---------------------------------------------------------- FINAL INSPECTION BY----------------- �_ ---------------- Date......�_"_f _ ----��------------ ----------------------------- i55 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California � f F.P.CO-