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F . ROFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------- ---- -- - ---------------- ------- (Complete in Duplicate) Date Issued -------------------_____________..__..___._____.-----.._. This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N 9. T�` 7 � 1?l --- ------------------•-------------- ------------- JOB ADDRESS AND OCAT ON... _ �/ Owner's Name------ f^4,_�:_ ------------- Phone-------------------- ` - - ---K-0 �--l�f_s---------------------- ---- ------------------------- - -----•--------Address----- _- -------- - r - - ----------------------------- Contractor's Name__ Ag_A&'---4:14�1�---- Phone//// ` - Installation will serve: Residence W�-<partmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Nu ber of bedrooms.- Number of baths ,/-_-- Lot size , _/�_.. _ __________________ Water Supply: Public system EjKCommunity system ❑ Private ❑ Depth to Water Table XIV7ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E]I--f-ISFclpan ❑ Previous Application Made: (If yes,date---------- ,_.__.---) No 92,-"`New Construction: Yes ❑ No L�,�HANA: Yes ❑ No j� TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well__.______=-Distance from foundation --------------------------------- No. G Material 1 - No. of compartments_________� ..__._Size___ __!�__, _ ��_Liquid depth_____ --------Capacity__4C ------- Disposal.Field: Distance from nearest well .-----Distance from foundation_- _ d ) Distance to nearest lot line__� ._. ____. Number of lines-------- _ ___ ength of each line--__1_7Width of trench_�-_�________________ _________ Type of filter material____��C7<' �Mepth of fiffer material-_ d %______Total length__ ____ _____________.___ Seepage i Distance to nearest well_____-'_..-___Distance from founclation/ )------------Distance to nearest lot line__��.___ Number of pits._ -------------- material-velC��__.Size: Diameter__rR_f�_.__.Dept h____;- ._Sj-~� Cesspool- 'Distance from nearest weal-----------------Distance from foundation-------..-----------Lining material__.______.___._______----------_____. ❑ Size: Diameter------------------ -------- ----------Depth----------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building----------------------------------_.___..- J ❑ Distance to nearest lot line------------------------- --------------------------------------- -------------------------------------------------------- ------- 'r a Remodeling and/or repairing Idescribe}:......G_2 .._-=- /J�J --- - vm/-------------------------------------------------------------- --- - f ._._Q ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- s I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t e San Joaquin Local Health District. (Signed)----------------------------------- --- ----- --- --- - --- --------------------------------------------(� Contractor) By: ------------------------------------------------------------------------ - -------- {Title) , / '----- _-_ ----------- - 3 (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY �f f APPLICATION ACCEPTED BY DATE ?--=X5'4 .;" --- - - ------- --------------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------- --------------- DATE-------- •-- ---- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- `. Alterations and/or recom ,nd +ions:----------- ----------- -------------------------------------------------------------------------------------------------------------------------------- .> t� . - __ ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ =-----•-- ----------------------------------------------- ---------------...•-------------------------------------------------------------------- ----------------------------- -----------------------------------------•-------- ------- ------------------------ ------------------------------------------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:.. ---- Date----7.-.-__- �^ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.a.c o.