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FOR OFFICE USE: ------------------------------------ __�� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --------------•------------ ------------------- ------- __ _--------------------------------- ___ This Permit Expires 1 Year From Date Issue Application is hereby made to the San � pp y Joaquin Local Health District for a permit to cans#ruc an+�stall the work herein described. This application is m de in compliance with County Ordinance No. 549. C>07-03 U ---------------- ��1 JOB ADDRESS AND CATION_ ___ t` -- `�'�"� `` - ` -- --- fhone------------------------------------ Owner's ---------- - � P ---- ----------•-------- Owner's Name------- v Address-_ Q- - Ph r. f - one. Contractors Name--------------- ----- -- ... -••"--: .fie <`°:,'", ---•- - Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --- Number of living WaPP Y units: _ ___ Number of bedrooms�� Number baths- Lot size pp ter Su I : Public stem Community system ❑ Private Depth to Wafer Table -F_-0 __�--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [:1 Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------"--.-------.l No ❑ New Construction: Yes [} No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` nce f am founds o -- Material----------- - --- ----------------- --------- Se " -- Septic anlc: �iotaof compartmen#s'nearest"well --->� -----Dista•,, �� ,�� quid depth------.-�-�.---------CaFac=tY--��-�,� *i nearest well__ r �-!Distance from foundatiol ___..Distance to nearest !of line��___-___ t- Dispos Field. Distance from e n - Number of lines.............. Length of each lice----�-�0------------Width of french..._1-------------------------- Number --.----- --- ------- "/ p of filter materialj4_1_'.__ Total length___-__ -- ----------f-•---- Type of filter material__ __ -- See a ePit: Distance to nearest well.- f �.----Distance from 'ndation____./- - --Distance to nearest I lin -..------.-_ p i� • � + Size: Diameter -�----�--Depth--------,? ------------ -- Number of pifs...-_ -__ __ - --Lining material-_._-_-5.-�-- -n' ^l\ Cesspool- Distance from nearest well ❑ well"_______ -_ Dfrm foundation__------------------Lining materia-------------------------------------- --- ____ i --- ----------------"Liquid Capacity------- --------gals. Size: Diameter------- -------------- ---------------Depth- - ;= — -:_.v"-----Distance from nearest building-------------------- ------ Privy: Distance from nearest well-------------------------------- ❑ Distance to nearest lot line------------------------- ------------ -------------------------------- --------------------------------------------------------------------- ------------------- Remodeling and/or repairing describe):------------------------------------- ------------------ ----- ; - ----------------------------------------------------- ---------------------------- [ ----------------------------- or ------------------------ rep- li the Sari t ---------In --- ----------------------=---------------------- " ! hereby cerci at have prepared this application and oaaumhLo�alkHeall heDi tnc}n accordance with San Joaquin County ordinances, Stat laws, rules and regulationsg -_ . ------------ w� er and/or Contractor) (Signed) -------- - =---------------------- ------------.--,, _{Title}----------------------------- -- ............ .-----�-- - BY ! (Plot plan, s win 'ixe of lot, locatio*osystm in r lation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY ----- -- - - --- --------------------- ----- APPLICATION ACCEPTED 4# DATE--�-----------� ----:---------—--------------------------- REVIEWEDBY------------------------------------- ------- -------------------------------------- -------- --- BUILDING PERMIT ISSUED----------------- ----- -------------••-------------- ------ ----------------- DATE------------------------- Alferafions and/or recommendations:----------_--------------------------_____-----_----------------------------------------------•-------•----------------- I ----------------------•-------- ----------------------------------•--- d r- 6 -----------•---- FINAL INSPECTION BY _ .- ------- -- ------ --- ------- Date------ k SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California