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FOR-OFFI9, USE: Permit No. ------- ------------ -------------- APPLICATION FOR-SANITATION PERMIT7 -------------------------------------- -------- (Complete in Duplicate) Date Issued .�_--------- ------ ------------------------------- ------------------------ - - This Permit Expires 1 Year From Date Issue lication is hereby made to the San Joaquin Local Health District for a permit toco�rugt and install the work rein descri l . A This application is madi c npliance with County Ordina jce No. 549. m< rr JOB ADDRESSA - --------------- ---- - (/ _ r { Owner's Name_ - Phone_ .......... . 7' ..... . Address----------- ---LQ- -•----- - - ------ o f p Contractor's Na ___ ----, / ( idence /A artment`F louse El Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Installation will serve: Res lel' p 1 Number of living units: -1----- Number of bedroom.- umber of baths P'- t size ------ __. Water Supply: Public system ❑ Community system Private ❑ Depth to ter Table l0_ ft. Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ C ❑FHA VA: Y❑es No ❑ Previous Application Made: (If yes,date_______----__ _____1 No (� New Construction: Yes o ❑ / ' TYPE kOF INSTALLATION AND SPECIFICATIONS: - (No -: / septic +anlC or cesspool permit+ed if&� 6i sewer is available within 200 fee{� orDistance from foundation_f--_.. -- __--.Material____ _----------------------Septic Tank: Distance from nearest well - ,� .1 y— -- No. of compartments_..___r�----------Size_-f�_.X-'O__-X--6--`�.Liquid depth-- 5�--.-.-------Capauty_ l6 Q'�.--Distance to nearest lot �ine___s�__-_____. --.-_Distance from foundation___ __..- Disposal Field: Distance from near e f well_ , " Len th of each line ; ��,--_��----�.•4�/Vidth of trench- 46 Number of lines----- ------- -- ---- - g ' Type of filter material -_. _.._ _ .__ Depth of filter material____. _ __�+ Total length________________� _-Q----- ---ft49-- Seepage f See a e Pit: Distance to nearest well--------Linin material Distance from foundation-----meter Distance tonearestlot line--------=--- gyp p 9 O ❑ Number of pits.. ------------------ 9 --.-_------_ - Distance from foundation-------- ----- Liquid Ca --cit gals. ---Lining materia-------------------------------------- Cesspool: Distance from nearest well ICY ❑ Size: Diameter------ ------------------- --------- Depth--------------------- ----------- _ Distance from nearest well------------------------------------ -- ------- --Distance from nearest building------.--------------------- Privy: -- .� Distance to nearest lot fine________________________-.-.--- ` Remodeling and/or repairing (describe�: -------------------------------------------------------------- ------------------------------------------------------- i ------------------------------------------------- ------------- ----- - ---------- --------- ------- ------- -------- ----------------------------------------------------------------- I --- ----- ---- ---------------------------- -------------------------------- ----------------- 1 - ---- - ------ -------- ------------ -------- ----------------- ---------------- - { I hereby certify that 1 have prepared this application and t + the wor i I be done in accordance with San Joaquin County ordinances, State laws, and sand regulations of the San J a i Loc ealth Districf. r �� ---_--- -_-------------- and/or Contractor)b (Signed)_ - - - _... -- ------ (Title]-.-�- . �- (Plot plan, showing size of lot, location of system'in relati o wells, buildings, tc., can 6e placed on reverse side). . "-FOR DEPARTMENT USE ONLY { i DATE _.-17__"�. ACCEPTED BY-------— I�` . -------------------------------------------- APPLICATIONDATE ---------------------- - REVIEWEDBY----:----- ------- ---------------------- ------ ------- ----- - -------- ----------- DATE-------- ------------ ---------------------- ----------- -- ` BUILDING PERMIT ISSUED----------•------------------- ---+--------------------------------------- Alterations and/or recommendations: - ------------------•----------------------------- 1 ---•--------•--- - ---------- ------------ -------------- -------------- ------- --------- --- FINAL INSPECTlO �1 Date----------- --------3:7/0--Z 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 E.Hazelton.Ave. Tracy,California Stockton,California Lodi,California Manteca,California I F.P.CO.