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FOR OFFIGF USE: r --------------- --- -------- APPLICATION FOR SANITATION PERMIT Permit No. ... �- ---------- Com lets in Duplicate) ---------------------------- -- -------- - ( p Date Issued -- - f S - ,This Permit Expires 1 Year From Date Issue" Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein�dS-CA This application is made in compliance with.County Ordinance No. 544. JOB ADDRESS AND LOCATION. _ - C c orn_A------- - Phone------------------------------------ At_:_C .L-S-------- Owner's Name1& (( Address--------------a �� on Ik Contractors e v f _ P �rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �,Nuymber tof bedrooms � � s L� p II Number of living units: _-/-- 3- Number of,baths -1------ Lot size 1 �2 Water Supply: Public system ,❑ Community system ❑ Private �epth to Water Table ft. l Clay Loam❑ Clay ❑ Adobe❑ Hardpan ❑ Character of sail to a depth 04.3 feet: Sand ravel ❑ Sa ' Loam ❑ y Previous Application Made: (If yes date_._-----------------) No Ej New Construction: Yes [�o ❑ FHA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND.SPECIFICATIONS: { (No septic tank,or cesspoo!_permitted if. ublic sewer is availablewithin200 feet.) .p.= ... _. lCCN Septic Ta : . „Distance from nearest well___SQ` --Dista ce �om foundation__ /-_ _ _Ma enol --- -- i---------- --- Ca acit __1_ __ . �� No. of compartments--------2 - --------Size--_"_ -----1101_'.--: Liquid depth------ � p Y 1' Disposal Field Distance from nearest well-- _.-Distance from foundation_--- l _.Di anew to nearest lot line`: ~--- Number of lines------------- -----------------Length of each line_-a-'_-75 -Width of trench___--- ,.---J---- ❑� Total ------------------- length-------- � Type of filter material___._V-CK--Depth of filter material____. ---.----- - Seepage Pit: Distance to nearest well._-_-----------------Distance from foundation .___.Distance to nearest lot line------- ________. . ❑ Number of pits------------- Lining material-------- -------Size: Diameter,----------------------Depth-----r-------------------- ❑ ------ e from foundation------------------ material__-___....-__________._-------_---- Cesspool: Distancie from nearest well_______________-D•stanc -Liquid Capacity----------------------------90's- Diameter . Dameter Depth------------------- Size. _ I` Distance from nearest buildin Privy: Distance from.nearest well----=------------------- ----. -- ------------------ ----------------- i ❑ Distance to nearest lot line----------------------- -------------------------------------------------------------------- 'I F i Remodeling and/.or repairing (describe)----------- -------------------•------------- -- ------ --------------------------------------------- - ------------------ --------------- ------------------------------------------------ it --:-- „- . - -------------- ---------------------- -------- --- ----`------------------ ----=---------------------------------------------------------------- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and mations of the Sa Joaquin Local Health District. } --------- ___ caner and/or Contractor) . ,.(Signed] � -= --�-�-�� -- ---�?�" -.-• - - ---------�- ---------- ----- ---- --- --- { tl � � ----- --- ---- -- --------------- --- -Ti a ----: -------- -- -- -- - --- - By: - ---------- -(Plof plan, showing ize of-lot;'lo`cation`of system^inrela#ion to wells, buildings,=etc:'can be, placf d`on"reverse`si a - '- FO`R DEPARTMENT USE ONLY �... APPLI _ ----- -------------------- --- DATE---- -.�-�_� 7-----�� CATION.ACCEPTED BY-------7-- �7` - ----------------------------- - ----- DATE------ ------- REVIEWEDBY----------------------------------- ---- DATE.--------------------------------- BUILDINGRERMIT ISSUED--------------------------------------------------------- ---------------------:-------- --- Alterations and/or recommendations:------- ----- ---- ----------------------------------------------- ---------=--------------------------------------------- -- ------- -------------- ------------------ ------- ------- ------------------------------ ------- ---------- - ------------------------ ------------•------ ------ ---- ..-: -- ---- FINAL INSPECT-IQA1 Bh•-- - -- -- . .�� --:i ----- --- -- - -- Date-------- --------- .-.... s_ SAN JOAQUIN LOCAL HEALTH DISTRICT f ]401 E.Ha:eltoa Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I - I Lodi,California Manteca,California Tracy,California Stockton,California ".Co. I