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FOR OFFICE USE- ------------------------- ------------------------------- ---------------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. - ------------------------•------------- ------------ (Complete in Duplicate) ------- -------------------------L------------- ----- - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in I th o k herein described. This application is made in co 1'ian ce with County Ordinance No. 549. _mp 5- if . i JOB ADDRESS0 -----------4 C " Owner's Name--- ---- 9 ADA_ Q--'-------------- --------------------------- ------------- Phone_ i Address. X/Con # CZ) ----- -- -- ------ ----------- ------------------------------------------------------------------------------ #64n- tractor's Nam -------------- Phone. Installation will serve: Residence Apartmeno ECommercial WF T iler Court Motel F Other E Number of living units: Number of lbedroom Number of baths = Lot size ----/62 Wafer Supply: Public system E] Community system jJ-10"rivate E] Depth to Water Table ft. Character of soil to a depth of'3 feet: Sand C] Gravel El Sandy Loam gj-�Clay Loam E] Clay [] Adobe [] Hardpan E] Previous Application Madei (if yes,ciate------------- ---- -) 'No New Construction: Yes *"No Ej FHA/VA: Yes U5000No Fj � TYPEOFfITALATiON-AND-51PECIFICATI-0 ---(N67-sWti6-+a_nk'or ciesspool per`m1++e'd'1f-&bIi -i6itir is ava'ili6le'w-ithin 200 feet.) Septic Tank: 41 Distance from nearest well__._________._ Distance from foupcla�?n__&_-------K/latenial----drew_*-- ----- ---No. of compartments---Z_ -- -----Sized"Kf_�460-__Liquicl clepth_-IIZA --------Capacity----Ir___________-�` Disposal apacity----- D;SP05a) Field: Distance from nearest welJ&D foundation____ _____.Distance to nearest I I- -----Distance from founclatio r Vwe_____ __. Number of lines-'- Lengtk of each line_9A?Z5_* 2-9 Width of trench.- ----------------- ype 0 Type filaAna- al-_ r material____F_ _____ length-------- _10epth of filte -------__Tofal I -- ------------------- -4- ali fr, Seepag elpif.- Distance to nearest well--------------------- Distance from foundation-------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining Material-----------------------Size; Diameter_--------------------Depth------------------------- Cesspoof�'! Distance from rearest well nearestwelL_________.._.r�'stance from��Disfance frcm foundation.-- ---- ------------Uning material-_._.....__.____._..__________-_-___-_-_-_- , El f,(L Vel!-Sjz,6:-D!aff4t:6rA......-----—---- ---'Depth----------------------------------- ----------------Uquid Capacity- --------------------------gals, Privy: Distance from nearest Well----------------------------_-------------- ----- ------ -----.Distance from nearest building------------------------------------- - _ F1 Distance to nearest lot fine-----------I------ _------------- Remodeling and/or repairing (describe):.-- ------------------------------- --------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ------ ------------------------------------ ------------------------------------------------------------------------ ---- ----------------------------------------------------------------------------------------------------- ----------------------------------I-------------------------------------------------------------- - --------- C4 ----------------------- ------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------ ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t laws, and rules and regulations of the San Joaquin Local Health District. (4V "T , - ---------------------- ------t ------- ---------------------------- ::!j Z! 11� tfor Contractor) BY=(Signe -----------------I-------------------------------------- ---------------------- _-J-9 ------------jif le)---------------------------- - (Plot plan, showing size of lot, location-of system in relatii to wells, builds s, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---'-77 R-!.-jQ------------------------------------------------------------------------- DATE----- Z-0 REVIEWEDBY----------------------------------------------*--- - ------------------------------------------------------------------------- DATE. BUILDING PERMIT ISSUED------------------ ----------------------------------------------------------------------------------.- DATE Alterations and/or recommendaf ions:-------------------------------------------------------------------------------------------------------------------- _---------------------------------------- --------------------------- ---- ------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------- ---------------------------------------------------------------- --------- ------------- ------------------ ------------------------------------------- ---------------------- ------------------ ---------- ---------------------------- ----------------- -- --- - ------------------- --------------------------------------------------------- --------------------------- -------- ----------------------- ----------- - -------------------------- ----- - ---------I...... - - - - --- - ----------------------- --- ---------------------------- - ------------------------------------- FINAL INSPECT! BY:. . .. . .. . . . . Date-------_--------- ----------- ---------------------- i. 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C 0.