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FOR OFFICE USE; f APPLICATION FOR SANITATION PERMIT Permit No. 02ol -3 ------------------------------ ---- ------------ ----- (Complete in Duplicate) I. Date Is ................................................... ... This Permit Expires 1 Year From Date Issued sued 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 Count Ordinance No. 549. "`"'^` PP P.. Y i0i�; 47—v°ro- Z?-- tS12fa. F_ , G: �m.p"�►).4c 2✓J: / ... ,. I�- ` JOB ADDRESS AND LOCAT ON _ _ t�l�' - R_�� __ __ -_ -��- - c___ _^__c� � Owner's Name----- - --- - ------------------- - ------ - Phone--l[----------------- ��ee � AddressSI4 -} `''' --------------------------------------------------------- ------- r Contractor's Name------ ---- . --- ------ -- ------- Phone.... Installation will serve: Residence Apartment House ❑ ► Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- __ Number of.bedrooms _s. _ Number.of,baths =1_ Lot size ____ __________________ if_____._._-_---_---_.___.---_-__ Water Supply: Public system ❑ Community system ❑ Private eDepfh Water Table ___ __ ft. Character of soil to a depth of 3 feet: Sand ❑,'Gavel ❑ Sandy Loam Clay�Loam ❑ 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 sewei•'is available within 200 feet.) ,t Septic Tank: Distance from nearest well_________________Dista rice from�founUation�--------------------Material------------------------------------------------- No. _____.._______ iF____.___-___-_______...______- No. of compartments------ ------------------Size------------------- -------- ---Liquid depth.----------' - - -------- Capacity_-------------------- 4 Disp Field: Distance from nearest well.__A®_--_.._Distance from foundation------!P._......Distance to nearest lot line__-5__f______ _ g ---------------------------Length r Type of filter material------- ._Depth of filter material------/__...........Total` length____ D__ _____-_____________________ Seepage Pit: Distance to nearest well-__________________ __Distance from foundation--------------------Distance to nearest lot line----------------- !L� ❑ Number of pits.--------------------Lining material----------------------.Size: Diameter----------------_---.-Depth11------------------------------- Cesspool: ------ n ❑ - - - P -----------------------------------Liquig material-----I�--- -- ------------------ Size: ---------- �Y Cess ool: Distance from nearest well_________________Distance from foundation___._.___._.___._.Linin Capacity..11___._____________-.-____gals. 7 Size: Diameter--------------- --------------- -De th---------------- t Privy: Distance from nearest wel3__.__..________________...___._.._____._._.---Distance from nearest building---------I� ....... F1 Distance to nearest lot line- ------ ------------------------ ------ ----------------------------- -------- -M - A Remodeling and/or repairing (describe)- ------------•----------------------------------•--•--------------------------------- ------------- , ------------------------------- ` ' I rIM _ -----------------------------------------------------------------------------------------------•-----------•---•-------------------------------------------------- --- -- ------------ ------!M------------------------------ --------------- ------------- ----------------------•---------------------------- ------------------------------------------------------------------------------ --•------------- ----------------- - -- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- -------- ---------- ----------- ------ and/or Contractor) By: a---- Tttle ilYf { ) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY +, APPLICATION ACCEPTED BY _, � _a �A ___'_ ___ DATE----- _-_ ._ REVIEWED BY-------------------------------- 11. ------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----------------41---------------------------- - ------------- DATE---------- - -----------------�M---------------- Alterations and/or recommendations:-------------- ------------------------------- .IM; ----------- ---------------------- ----------------•---------- --------------------------------- -------------- --------I------- --------------------:---------------------1-------------._..--------------- IM l I � -- � - FINAL INSPECTION � _.. ------------- Date�-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street_; Stockton,California Lodi,California Manteca,California Tracy!!California i� i.