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FOR OFFICE USE: - --�------ --- -------- -------- --- ------ APPLICATION FOR SANITATION PERMITPermit No. --------- ------------------------------- (CompleDate te in Duplicate] Issued -------------------------------------------------------- ----------------------- -- ----- --------- --------- -�----�-------• This Permit Expires 1 Year From Date.issue made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION-------------[CR81-------we--- a-�------------------------------------------- � ----r- .�-------------------------------------------------- --- • ----- Phone-- ----• _ - - � 1�� Owners Name------------------- •-• .-- ----------- --------•-- 1 Address---------------------------------------.�_0�'-R-�------�--C_ ��,�--- ---------]-2�5-.�-------------------------- - Contractor's Name---------------- --------------------------------- ---• ---------------._. Phone--------------------- ----•---- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t 9" __ -.- Number of bedrooms __ � ---•-----------•----- ---------- ---- Water of living units: -- �_- Number of baths __ .____ Lot size ________ _ Water Supply: Public system ❑ Community system ❑ Private E u'epth to Water Table _____ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [. ardpan ❑ � FHA/VA: Yes No ❑ Previous Application Made: (If yes,date.__--.---_.------- ) No New Construction: Yes ❑ No 0 �;�� ..,,rte- •.,�,�,�� 4. - -_ -� -�� TYPE OF INSTALLATION AND-SPECIFICATIONS_:-'- T' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <QN) Septic Tank: Distance from nearest well----------------- from foundation---------------.-__.Material------------------------- .---------------------- 1511 No. of compartments---------- - -------------Size--------"-------------- -------Liquid depth------------- - ---- Capacity r Disposal Field: Distance from nearest welljQ_0......Distance from foundation-___7J__..___-.Distance to nearest lot he___ ---------- Q Number of lines--------------/-. - ----- --------Length of each line----------9_o------------' idth of french--------I-,--------------------- ,,,_fl�y�r Type of filter material-_ ----Depth of filter material- .1. _ ____..Total length---____.._._ -------------------- Selepage Pit: Distance to nearest well__----------- _------Distance from foundation--------------------Distance to nearest lot line----------------- I ❑ Number of pits----------------------Lining material-----------------------Size: Diameter - Dapth Cesspool: Distance from nearest well________________Distance from foundation------------------..Lining material.______----__..___.__--------.----- Size: i7iame#erDepth Liquid Capacity gals- ------------ A ��❑� �� —�F � ...___.._Distance from rest'�building--------------------------------------�-� Privy stance from nearest well-_____ ____ ____ ___ ______ ___ l /� D stance to nearest lot line.____._-_..___________________ _ ___ ------- --- Re fp ,,�rM e rad repairing (describe): ----- -------I-'- ------o ------------------ ► ----------------•-------------- --------------------------------------- 4 -------------------------------------------- --------- ----- I 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 regu ations of the San Joaquin Local Health District. (Ow ner and/or Contractor] (Signed} (Tale]._ iBy:--------------------------- ----------------------------------------------- (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_ -- DATE �"� 2, REVIEWED BY---------------------------- --- --------------------- ------------------------ - ------------------ DATE----------------------------------- •----------------------- BUILDING PERMIT ISSUED----------------------- - ---•---------------------- - DATE---------------------------------------------1--------------- . _-_ -------------------------------•------------..----------------- Alterations and/or recommendations:._._-- ...... ' -----------------------------------------•------------------•- ------------------------------ ------ --------------------• ----------------------------------------------- 1 ----- ------------------------ ------------ ------------- ,FINAL INSPECTION 8 . Date-----------9' � (7 ----------------------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 'r 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,CaliforniaLodi,California Manteca,California Tracy,California tGkf�'� _ �,:y+. •� f F.P.CC.