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FOR OFFICE USE: - Q ` 6n M =1 -- ------�_�.� -�-11�--- .- - Permit No. _ APPLICATION FOR SANITATION PERM - (Complete in Duplicate) /� 7 ------------ Date issued ------1-� - ----------------- - This Permit Expires 1 Year from Date Issue d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her describe This application is made in compliance with County Ordi ante No. 549 ..• -------------------•------------------------------------------ �- JOB ADDRESSnDLOCATION Phone ///J,�` -- --•-------------------- Owner s Name--- -------- ame-- _...-._.- 2 `. -Z._ . Address---------- ` --------- Phone------------------------- --------- Contractor's Name__ -_ - - ---------------------- ---- installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size . - ----------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table Z40 ft- Gravel Sandy Loam [:1 Clay Loam ❑ Clay E] Adobe[Hardpan ❑ Character of soil +o a depth of 3 fest: Sand ❑ ❑ any �, � FNA/VA: Yes ❑ No ❑ I Previous Application Made: (If yes,date----- -------- -----� No . New Construction: Yes [to ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) `! --- Septic T k: Distance from nearest weli_+� --------Distant from foundation--_ o�-- ------.Materia-_- ___-- ------------------------------ -- 1 1«-V Li uid de th----- - Capacity-- No. apacity- � - V4. No. of compartments---C ompartments--- -O.`- ---i----- Size- / q P� f. -,�---_-.Distance to nearest lot line--'►�-.-_ �_._�'+�-' �__- Distance from foundation--- r• Disposal Fie Distance from nearest well-45-4-------- � Width of trench__--s� -- Nof lines___-- _ --------Length of each line-_.lir-B--------- -------- ------------- umber - Type of filter material._�!�13�f�---Depth of filter matenaL-��__--.--_---Total length__----__---_---_ �-� --------- Seepage Pit: Distance to nearest well--------------_-_----Distance from foundation-------------------DI to nearest lot line----------------- ❑ Number of pits---------------------Lining material-----" ----------Size: Diameter-----------------------Depth--------- ----------------------- % Cesspool: Distance from nearest well ------Distance from foundation._--_-.-_-_-._____.Lining material--_---.-- Size: Diameter- ---- --------- ----------- ----- -Depth--------------------------------------------- ---- Liquid Capacity gals. ❑ ,_ Distance from nearest building ------------------------------------------ 11. --------------------------------- Privy: Distance from nearest well--__--.._------------------------ ❑ Distance to nearest lot line-_.--_- Remodeling and/or repairing (describe):_--- ----------- ---------------------------------------------a -------- ------r--_----c--- --y- t-a- p p pp Sa Joaquin Local Health District. : ------------- - ------------------------------------------ ---------- - -- ----+he------------------------------------------------------------- ------------------------------------------ y I hereby certify that I have repared this application and that the work will be done to accordance with 'San Joaquin Count i ordinances, State laws, and rules and gulations of 9 Owner and or Contract __.. Si ned - ------- -- ---- - ------------- --- ---- ( r( ----------------------(Title)------ -------- By: -----•---------- esst�im' �:(Plot plan, showing size of lot, location of in relation to ells, buildings, etc., can be placed an reverse side]. — FOR DEPARTMENT USE ONLY �i ! o ----- DATE-----'l_--------- h APPLICATION ACCEPTED BY--._ ------------ REVIEWED BY----- - ----------------- DATE BUILDING PERMIT ISSUE __-____--_-________________ -------------- -------------- DATE t Alterations end/or recommendations:--------------- ------------------ ----------- ----------------- ---- ----------------- --------- --------- - - -- - -- -1— � Date ----- ----------- -- --------------------------------------------------- FINAL INSPECTION BY:- 110 SAN JOAQUIN LOCAL HEALTH DISTRICT ]601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street • Stockton,California Lodi,California Manteca,California Tracy,California F.P.ca. r^