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FOR OFFICE USE: --------------- !i APPLICATION FOR SANITATION PERMIT Permit No. . ------lv ------- n (Complete in Duplicate) - ii This Permit Expires 1 Year From Date Issued Da+e Issued ._. _:_ Application is hereby made to'!the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is mace i compliance with County Ordinance No. 549. : 7 —20-0 —(� 01 JOB ADDRESS A LO TI 0 --- _._ 1- r Owners Name • ------------------------------- --------- Phane_ ��_"_.may�.. Address-----------------------`P--- !`f• �G' "R ------ - ----------------------- -------------------------•--•--------------------------------- t Contractor's Name----------____•___ --_--_ Phone_ G - ,��/ -moi --------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I�__I-_ Number of bedrooms ___az Number of baths __/__ Lot size -_.o?Q-- ------------------- I Water Supply: Public system j❑ Community system ❑ Private Depth to Water Table '?Q_ ft. Character of soil to a depth of 3 fee+: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ u Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No FNA/VA: Yes.El No [I � t TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S : Distance from nearest well-----------------Distance from foundation--------------------Material..-.._-__ _ .. ______ _-.____-..-___ _._...____-----. �� pf arsk� No. of compartments---------- - - ----------Size--------------------------------Liquid depth---- -------------------- Capacity-------------- ------• I u t Disposal ield: Distance from nearest well_.5�.,..-___-Distance from foundation--/P--4..........Distance to nearest lot 20-00 Number of lines_________ ___.-__Length of each lire----- of trench__. .`+--______________,____-__ Type of filter material-_J��__I _'-0A V__Depth of filter material------/1._ -----Total length______________________�_-3__d____.-.____ N II ` $`� Seepage �t: Distance to nearest well__�_�a_....____Dis#ance,f.�om foundation_�o__�____-_._.DaJi_Distance to nearest lot iin�-_.________-_.__ � &01Number o i pits------- -----------Lining mate ria l-- /-tl_Y!�_---Size: Diameter._..-------.------__--Depth_._- -S___-____-__-____------ Cesspool• Distance from nearest we!k-----------------Distance from foundation--------------------Lining material---.____.._.-_.-_______-____--_.---_ ❑ Size: Diameter---- - ----- ----------------------- Depth------------- ------------------------------ --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------- Distance from nearest building______________________--._.___..____--. .? ❑ Distance to nearest lot line------ -- ----------------- ------------------------------------------------------------------------------------- ----------------- s II Remodelingand/or repairing i(describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- II ------------ ---------------------------------- I) I hereby certify that I have prepared this application and +hat 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. J ' I $i ned ''�'�' _______________________(Owner and/or Contractor) arG (Signed)- By:9 )------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- =_X_ ------------------------- ------------------------ ------ DATE----------- / ----- -- ------------------ - REVIEWEDBY-------------------------1j---------- ---- ------------- ------- --------------- --- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED_-dl. ----------------------------------------------- ----------------------- D AT E------------ ----------- --------- --------------------- Alterations and/ r re ommepda+ions:____ w-i`o_ _ ' -•---- --------------CSG ----------------------------------------------- --- ----- ------------------------- --- --- II I! -------------- �� Y - -- ---------------------- FINAL INSPECTION BY:-Ji... ----L-- ------------ Date------------ .f -. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca,California i Tracy,California II