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FOR OFFICE USE: ----------- l ' ........_______--------------__________________ APPLICATION FOR SANITATION PERMIT Permit No. -- � ------------ ----------- ------------------- (Complete in Duplicate) -------------------- ------ ----------- 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 install the work herein described. This application is made in compliance with County Ordinance No 49. JOB ADDRESS AND L ' TION_-O✓�D---- F�$ Owner's Name------ --- _ tr-fl------ -• - -------------------- ----- ---...... Phone------------------------------------ e - - - Address---------- _ ` Contractor's Name-------------- -------------- Phone_------------- --•-- - - -• - -•-- --- ----•------•--- -----------•---------------------••----•--- ---------------------------•------- Installation will serve: Residence Rj'_Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1-- Number of bedrooms Number of baths --e-. Lot size -1�- _ -eoge ________________-________.__-_ Water Supply: Public sy tem [+Community system ❑ Private ❑ Depth to Water Table d ft. Character of soil to a depth`of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®/Hardpan ❑ Previous Application Made:111f yes,date------- ----_-_.- -) No J�j' New Construction: Yes ❑ No g?'-FHA/VA: Yes ❑ No j;j— TYPE OF INSTALLATION Q AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5 Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material _.--__.___---..----_._.__---_-----___---_-----. ----------.Liquid depth _---------------------Capacity------ ------- -------- No. of compartments-.-.----•-----------------Size---------------•.-- . -,�^y , J Disposal Fielder Distance from nearest well-----------------Distance from foundation---.l��-___--.-Distance to nearest lot line- --__.-- . Number of lines-------- ------/------,_ Length of each line__ _---_-`----_-,Width of trench-.��- Type of filter material Q,�f Depth of filter material__ -.._ _-_.Total length__2e- _----__----__- ILS' p /------------ in -Dist n e fro fou ation-a; f Seepage-Pit: Distance to nearest well _____________ _ �_.--_.- Distae to nearest lot lige- -------_ 4 -Number of its---- -__ - g -D ,,'al' Size: Diameter.-y, , ---------Depth Cesspool: :' Distance from nearest waif-----------------Distance from foundation-----------------.-.Lining material------------------------------------- 0 ❑ Size: W 0 th- --------------------------------- p -- --Liquid Capacity- ------------------------ gals. Privy:-( r - Distance from nearest well----------------�-------------------°------- ------� -----... -� -----------------f--r-o-�m--�--n--eare--s-t----b-�u--il-d---in Dsance to-nearest lot line - - rn iRemodelingAnd/or repairing (describe): / •------- -------------- -. ----------------------------------------•----------------------------------------------- r I herel;,y 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 andjrela+Tiansof the Sa Joaquin Local Health District. + (Signed)_`r----- -' - ------ --- --- - ---- ----------------------------------------(�r Contractor) B W---- Y' '- ----------------------------- Titl ( /z_ ee- ------ --- ---- ---- -------- (Plat plan, showing-size of lot, location of system in r on +a wells, buildings, etc., can be placed on reverse side). }Y7 b f " OR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY-------- REVIEWED-BY ------ - DATE 1-1 ----- -------- REVIEWED.B.Y_- -----------------------------------=------------------------------ DATE.----------- - BUILDING PERMIT ISSUED------------- ---------------------------------------------------------------- DATE ,� -------------- ----------------- Alterations and/or Y men ti ns: ----------------------------------------------------------------------------------------------------------------------------- 1 ; ------ ---------------------------- --------------------------------------------------------- ----------- ------ t--------- f `� --------------- 11-6 1 1��a - _ --------- - / ¢ c �-5 --- - -•- - -.--- / FINAL INSPECTION,BY f ...... - --------- Date.. .----- AN JOAQIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ,124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California