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FOR OFFICE USE: ------------------- - - -------I------------------- ---------------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. 4?------ ..... ----- ------------------ - -------------------- -,(Complete in Duplicate) 1Date Issued ------------------ F -- ------- --- -- ---------- . FThis' Permit Expires 1 Year From Date Application is hereby made'to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made x/100in compliance with County Ordinance No. 5r49f��. 7telj CLx V415E ... . . , (,JOB ADDRESS AND LOCATION __ � Owner's Name --- ------------ ---------- ----- ......... ---------------------------------------- ---------------------------- Phone.................................... Address-----•-- • fr'_ _ '_..- `�' •=- - .... Contractors ddress--------- ContractorsName- --------- -- ---- ----------------------------------- --------•------------------------------------. Phone.............. ---------_-------- Installation will serve: ResiHence artment House E] Commercial E] Trailer Court E] Motel [3 Other Number of living units- :77��Number of bedrooms __C;--NG_rnber of baths -------- Lot size ----9-��----/.__//4__1------------------------ Water Supply: Public system, _E_3 Community system [-] Private ly Depth to Water Table ft. Character of soil to a depth of 3 fee+:. Sand fj Gravel E] Sandy Loam E] Clay Loam 0 Clay ❑ AdobA Hardpan ❑ Previous Application Made (if yes,date. New Construction: Yes E] No FHA/VA: Yes E] Nor' r 0 1& No E] TYPE OF INSTALLATION ND SPECIFICATIONS:.- (No'septic A o—rcesspool permitted if public sewer is available within 200 feet.) Septic Tanker Lim Distanc e from nearest well_________________Distance from foundation---------------I-----Material------------------------------------------------- 4 No, of 1tompartments------- ....Size--------------------------------Liquid clep�h--------------------------Capacity-------------------- D�ip2sal Field Distance from nearest well-----------------Distance from foundation------------------- Distance to nearest lot line_._--.__________- El be' of lines_________ _ Length of each line------------------------------Width of trench--------__1--_------------- T T, ype of filter material-__._- ------_________Depth of filter material_________ ____________Total length_______________.__.-.._,________-_-_-___"_ r Seepage ength----------------------------------------- Seepage Pit: Distance0 to nearest well-- -------------------Distance from foundation--------------------Distance to nearest lot line__._-._____-_____ , ----------- El Number, of faits---------------------Lining rnaferial-----------------------Size: Djamefer----•-------------.----.Depth--------------------------------- '!I! Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material______._.______________.___.________. ❑ Size: aferial-------------------------------------- Size: Diameter_ -- - --------------------Depth---------------------------------------------------Liquid Capacity- --------------------------gals.im, 4— Privy: Distance from nearestwell-------------------------------------------------D isf a nce Jrom7ea rest building --------------------------------------- r_1 Disfanct to nearest lot line--- -------------- ------------- ----- J --------------------------- Remodeling.and repairiii --------------------- ------------------ ---------- - ------ ---------- -------- ------------- ------------- ---------- ----------------- ------ 1---- --- ------ -- --------?. --------- - ----- ----------- ------ ---------- ---- ---------------------------------- ---------- ------------------------------------------------------------- here ertify that 1'.aye prepared is application arfy- -that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. (Signed] --------- ------------------------------------------------------------------------(Owner and/or Contractor) -- -- --- --------- A_/_I— _------------------- I------------------ 11, -=--------_-------=---------------------------------------!-=---------- (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE61 BY--- - - - ------------ ----------------------------------------------------- ------------ DATE ---I----------------- REVIEWED BY --- ------------------ BUILDING PERMIT JSSUEDT,_-,--- -------------------------------- ------------------------------------------ ------- DATE--------------------------- ----------------- Alterations ATE--------------------------- ----------- Alterations and/or recommendations:--------------------- ------------------- --- - -------I—------------------------------------------------------------------------------------------------------ --------------- ------------------------ -------- 71 -7T ---------------------------- ------- ----------------------- -------I-------------------------------------------- - --- ------------------- ------------------------------ --- ----- - -- ---------------- ------------ ------------ ,e�-/---- --- ----- ---------------------- A -- ----- --------------- -------------------------------------------------------- - ------ e&-p-C - ------------------ ------------k" ------------------1............... -- ---------------------------------- ----------- --------------------------------------------- ----------------- ---------------------------------------------------- FINAL INSPECTION BY1____ ------------------------------- Date...... --------- ----- ---------------------------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California 15 9 REVISED 8-99 glu 161LI11:bl",