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7---FOR ,- OFF4CE USE: ------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. ----- -- ----------------------------- -- (Complete in Duplicate) ? P 1 Date Issued _.'�-�-��----------- "-"" -------------------------- -------------------------- This Permit Expires 1 Year From Date Issued- ------ and install the work herein describe d. Application is hereby made to the San Joaquin Local Health District for a ermit to construct This application is made in compliance with County Ordinance No. 549. f-Aa+ 37-2. f JOB ADDRESS AN LOCATION It _" ' t Phone. Owner's Nam -- ---•- -- _X ---•-----------"- ------'•-------------------- ----•--•-- L g -------------------------------- Address_----• one_------•------•-•-------•---------- - -, c Contractor's Name-- - - ------ ----- ---/- - �---- k Installation will serve: Residence [i� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------- Water _ Number of bedrooms Private De Depth to Water Table r. s P -------- ft. "" Number f baths __ ____. o size l Supply: Public system ❑ Community system ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam ❑ Olay Yes ❑ Nolay❑ FHA/VA:a s ❑Hardpan dan No Previous Application Made: (if yes.,date--------------------1-No ❑ New Construct ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance -from nearest well__--_____--_____Distance .from.foundation--------------------Material-___-___._"_. -------------------------------- I -----------_----- - r i No. of compartments---------- ---- ---------Size--------------------------- Liquid depth Capacity pis�sa field: Distance from nearest well--=5Q"i--__Distance from foundation___A...."""_-Distance to nearest lo---------------------------- / line_S___"_______ � /:.-`` ---------Length of each line-------0E3`"�......---Width of trench- ..Z . LQ Number of lines___. _________-- De th of filter mater al___,C y_._-__-____ -Total length-AP-0 Type of filter mat&ial_Z�-�- P . . r Seepa Pit: Distance to nearest•well__fPjq----------Distance from foundation-_19-------___.1) naac��o nearest lot line,______.-___.__ Number of pits-_-------_1---------,Lining material------ . -- '--- -Size: Diameter------- �C_- Deptn �ti ------------------- R1 . f Cesspool:# Distance-from nearest well______-_______-_Distance from foundation-___------- ------Ltinuid Capacity gals. ❑ Size: Diameter-- ----------------------------------- ----- --- --- --- ------- -----DePth_..-------- --------- ----- --------------------- Distance.-from.nearest wei4----------------------------W EL stance from nearest buil" in—o„_-,_"--- ---_-_-- -- - Priv �_.�, �.�: ------- ------- ----------------- lot ------- -- -- ....tea.- lot line�, may❑ ---------------------------------- Distance --------- to nearest lot _-_.___- ---- ---------------------------------- , � • w ----------------• Remodeling and/or repairing (describe]:--------- --- - - •-- - - --------------------•----•------------------------ ki - ------- -•------------ ------------------=-------------------------- and ` --- - ----•--- ------ ------ -- - ------- ---- ---- -- -: --- -------- - - - that wor wi I hereby certify that I have eepand regulations olf tation he San JaaquinhLocalkHealltheD s}�Icfn accordance with San Joaquin County ordinances, State laws fi ? .and/or Contractor) --- St ned ---------------------------------- By: --- - ----- - (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•-- ----------- ---------------------------------------- DATE------------------------------- ---------------------- REVIEWED BY- ------------------------ --- -- ------------------------------- ---------• DATE-------------------•---------------------------------------- REVIEWED ---- - ---------------•---------- - ------------------- --------------------------------------------- BUILDING PERMIT ISSUED--------- __ _. Alterations and/or recommendations:._-__ -.” ti . ---------------------------------------- -------------------------- --------------------------------------------- Date_ INSPECTION BY:..L. — ----n"r', ------------ - Da+e 3�r ------------------------ SAN IN LOCAL HEALTH DISTRICT 1601 E.Ha><elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F.P.CO. 4