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ZED ---------------------.;----- q {� f --------------- I� APPLICATION FOR SANITATION PERMIT Permit No. .. .1_�_ a l (Complete in I1- This Per6uplicatel -- mit 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 install the work herein described. This application is made injlcompliance with County Ordinance No. S49. JOB ADDRESS AND LOGIATION_17440 ' --- _ ..... t , Owner's Name-_-_ 0 WtAd I --- - // ----- :.. ----- G Phone-. Address..---�. .....7 ... __:._�_. # _ .: ;' * -------------•------_ Contractor's Name. �._S Z ----------------------------------------- s Ph ne C Installation will serve: ResidenceApartment House ❑ CommercialTrailer Court .' a�-M, Ili i ❑ ❑ I?te1 �[]',,;�Other ❑ Number of living units: Number of bedrooms Number of baths __ __ Lot size e9 w i Water Supply: Public system 1!�. Communit s �`� y stem y ❑ Private ❑ Depth to Water Table _."�S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ :Clay ❑ . Ai cbe.[q-�"•Hardpan ❑ Previous Application Made! (If yes,date____ _______________) No 2' New Construction: Yes No 0 FHA/VA: Yes ❑ `No>�''r TYPE OF INSTALLATION II SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) If` �I �� Septic Tank: Distance from nearest well--- ..__.__Distance from foundationf4�_______________Materi�l_._..._�___.. ------------- No'. of com artments_:-_ 0`-_ �_.__Li ui --------- -- p --- ----!Size JC1.. Capacity..rpA .II. !; -- -- -- Liquid depth.---�------- Disposal Field: Distance from nearest well....'-- --------Distance from foundation----1_d---------.Distance to nearest lot line_-_til_:-._�...'. Number of lines__.-_.I-------------------------ILength of each line !Q --_____-----.__Width of trench.._.;9��_y 1 Type of filter material_- ti../t--..._-Depth of filter mater' l__� -4 Total len th__.__` .� Seepage Pit: Distance to nearest well_.__' _ ______Distance from found io !'_a-tDisfanc� o�nearest lot line---'�-___._-: J Numberllof pits...._.._._____..__Linin material` C-�_____--Size: Diameter___.- -- p " gDe thn3 ---------------- Cesspool: Distance from nearest well__----__._-__._Distance from foundation____________________Lining material1 ff !I ❑ Size: Diameter------ -------------- ---------------Depth--------- f ------------ Liquid Capacity----------- -------------.--gals. Privy: Distance from nearest well------- Distance from nearest buildin9----------------------------- - ❑ Distanceiito nearest lot Ione-------- ------- 1 ` . Remodeiing and/or repairi Qgi (describe):------__..____-_.____-- .i -------------------------------------------------------- --------------..._ - ------------------------------------------------------ 1 ---------------------------------------------- 1l:----- -------- --------------------------------- ----------------------------------------------- ------------------------------------------------ - ereby certify that I 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 the San Joaquin Local Health District. (Signed)------------ r BY --------------ill!------------ -- ---------------------------------------------- ---------------------------------------------------------------(Owner and/or Contractor) ' --- ... -- - - - ------- - --------------- ---------------- --------------------------------------(Title)------- -------- - ----- (Plot plan, showing size of lol, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---__!-_._fit --------------- ---•- DATE_ _1�o-- . : f� 7 REVIEWEDBY----- -- --------- ---�I��---------- --------�------- -- ------ ----------------------------- DATE------------- ---ii� ---------- ' II BUILDING PERMIT ISSUER----------------------------------------- -------.•---------------- DATE = Alterations and/or-recommenda$i�ons _______ _�� - �. _.. . .. .. -. ---- ------- ------------ - �� -- .. ------- -- ------- ----------f t -------- -------------------------- --•--- � •� + —C mi=l.--- ------------ _` �� ^-•-� l .; a -� � PF' --------------------------- r - -------------- - t FINAL INSPECTION BY:...._`_---.- -. 4 . / 6 �---• -- --- 1'-��r�-- Date---- � ! � --------- ---------------- A ------------- - AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California i Lodi, California Manteca,California Tracy,California r.! CQ. ,