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----- ------ -- ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .__! .3-� -__ 4 - ----------• ----------------- ------ --- {Complete in Duplicate} 1 - 'This permit Ex ires 1 Year From Date Issued Date Issued � -- [ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbad. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANLO ATi N--- ------- Owner's Name -----------------------•- ------------ - ` Address--------- A�J - - -------- --- ----------------- Phone-------. - -� �r.----= --•----- •-------•-•- Contractor's Name.__="__:__f ---•-- ---------- --•---•-----------------•----------"----------•--- � , •- * --- ---- Phone: nstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units:--/--- Number of bedrooms A. Number of baths _ ___ Lot size __�j" -Y - Water Supply: Public system f®f f - ,f,�� ----- Y Community system ❑ Private ❑ Depth to Water,Table 7.`04a {t• Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam C] ClHardpan ❑ Previous Application Made:'flfYes, date_____________""-"--"J No ay El Adobe TYPE OF INSTALLATION'AND SPECIFICATIONS: New Construction: Yes ��o FHA/VA: Yes ®''�No ❑ f -r (No septic tank or cesspool permitted if public sewer is available wi+hin 200 feet:) _ Septic Tank: Distance from nearest wd_-""-"• ----Distance tom foundation.__ 3 No. of compartments ,� --------Maferial__C-4-" � t/j .--Size_,' " -------" ---` --�V�__Liquid depth-""-';� __ ___ Disposal Field: Distance from nearest welt.._.- ---- -.Distance from foundation__._ -Capacity__- ------ Disposal �� _.___.Distance to nearest lot line-_s.� �--_. 9 Number of lines----- -:-"_--_ ---" Length of each line--- Type-of filter material off;-------Width of trench____-`--•-. 1 _Depth of filter material_Aee -r-:; 4. Total length__-__ �1-------------------------- Seep Pit: Distance to nearest well_-- _ --------Distance fr m fo ndation__ Number of pits._ �••le—Dista ce to nearest lot line.-4", ---/ Lining maferial_-AQ -_Size: Diameter_ �� j .-------Depth--a2� -"---------------- Cesspool: .Distance from nearest well Distance from foundation.._.____",`--.�, ❑ Size: Diameter- --.Lining maferial----------------------------------------------------------- Privy: --------- Capacity gals. ProvY: Distance from nearest well._.._ ___.____Distance from,,nearest building❑ Distance to nearest lot line--,--- -------------------------- --------------------------------------------------------------- - Remodeling and/or repairing (describe):_,W:--•-----4�- ----_ ------------------------- -------------------------- -----------•------------------------ ---------------------------------------- ---•------------ -- --- - - -- ---•--------- --- ------ ------ -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Jo ordinances, State laws, and rules and regulations of the San Joaquin Local .Health District. aquin County (Signed)_--- '' ' t ------------------------ --- ---•----•-- - �-�. (Title)- (Plot � Contractor) or) plan, showingsize of lot, location of syste n relation to veils" buildings,etc a plac ' `reverse side). FOR DEP T ENT USE ONLY APPLICATION ACCEPTED BY-___._ .--___- ___ ------ ------ ---------------------- DATE------------ REVIEWED BY - ." UILDING PERMIT ISSUED •. = DATE. ................... ------------------------------------------•--------------------------------- D Alterations and/or recommendations:---"- •-------•--•----•----•--------"-"------------------------------------- -----------------------------_� _ -•----•----- -•-----------" ---- DATE ------------------ --- :- ---st ---- �._=-- -----------------•- FINAL INSPECTION BY: ". - --- ---------------- �------ ------ Date----�^� SAN JOAQUIN LOCAL HEALTH DISTRICT i 30 South American Street "12 300 West Oak Street *. \, \ ° 1 Stockton,California - 4 SYS ore$free' Lodi,California 205 Wes!9!h Street Manteca,California ES-9 Arvicro B-59 F,p,CO.2M 6.60 Tracy,California