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_ FOR OFFICE USE: X +-« -. Permit No. APPLICATION FOR SANITATION PERMIT y , T --------------- (Complete in Duplicate) Date Issued ----------------- This Permit Ex ires 1 Year From Date Issued e San Joaquin Local Application is hereby made to thl Health District for a permit to construct and install the work,herein descr Al e This application is made in compliance with County Ordinance No. 549. _ _ JOB ADDRESS AND LOCATION---- -�-- /,3�-------- .. �----- ------- ------ - ---- - - -- - Phone.��.--*��---- r owner's Name --- -----• -------------•------- Address--------------------- •------- -- �l. Contractor's Nam Other Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ ate � -------------------- --------- Number of living units: I-----" Number-of bedrooms -� Number of baths - Lot size -',,_-///��-,, ------ ----- , I Private Depth to Water Table 44 ft. Water Supply: Public system �mmunity system ❑ ❑ P Character of soil +o a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Yes ❑ard No ❑ Previous Application Made: {If yes,date--------------------I No ❑ New Construction: Yes ❑ No [p-THA/VA: E i TYPE OF INSTALLATION AND SPECIFICATIONS [No septic tank or cesspool permitted if 1 ublic�sewer is available within 200 feet.) l� Distance from nearest we11_.____.__ . --Distance from foundation------------------ Material......-------------------------------=----------- is Li------ ,quid de th - - ---------Capacity------------------ No. of compartments------------------- -------Size---------------------------- q � D.iepos Id: Distance from.nearest welL.i _O:Zt�-�_Distance from foundation:r�..___...._...Distante to nearest lot line_ Number of lines----_l�_-- -Length of each line_,_7?0-,_50Width of trench.._- -ff------"----=- Q--------- -- ._ Type of filter materia. _�.---.-- ---------------------- -Depth of of filter mater�a4_�.�_ _____._._._Total length_._____. ,.�� Distance from foundation____�eQ_"___.Distance to nearest lot line---_-'�.dt------ e ge Distance to nearest well_R�- -.----- - • /� �' - Q Number of pits--- ---------------- Lining materiaL_If � --- --5ize:� Diameter-- ,}---------Depth._-5-------------- �, _ W i Cesspool: Distance from nearest well-- from foundation_________ ________Lilquid Capacity----__.--------------------gals. ❑ Size: Diameter------ -------- - ------ ---- `_De th------------------------ ---- -- .Y _Distance from nearest,building._.._____--------------------•---------- Privy- - ----- Privy: Distance from nearest well-------------•------------------ , ------ - Distance to nearest lot ine___.____--------------...----.----- -- ----------------------------------------- ___________________________ ----------------------- Remodeling _- ---__-----.--___. Remodeling and/or repairing (des'ribe}:---------------------- --_-- I-------- -------------------- ----- _ Q' = R l -----•--------- ----- ----- ------- I Q 1 - `� o i " - --------------------------------------------- t -------- ---------------- I hereby 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. kz7ve;�-- -- - jbvm�r Contractor) i (Signed] ` - ---------- --------- ----------- -------- -------- ---------- - -- - ---------------- -- t ITitlel-- - --; I (Plot plan, showing size of lot, location of system in relation to ells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY = - - ---------- ----------------------------- --- ----- DATE----.-��--~.I/1 ----- ---------- DATE---------- ---------------------------------------------------- REVIEWED BY----- ------------------------------ ------- --------------------------------- --------- ----"--- - BUILDING PERMIT ISSUED-------------------------------------------------- DATES + a `� Alterations and/or recommendations:_.__, "�- -=-�-J`J alb------'G=-�----------------------------------------------------------------------------------- -- --- -----------•------------------------------- ------------------------------------------------- ------------------------------------------------------------------------ ------ ------------------------------------------------------ -------------- ----•---------------- -----I-------------- -------- ------------- --------------- - ----------- - ---------------------------------- -- FINAL INSPECTION ------ -- ----- 2 Date_ __.:.---- --- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elion Ave:. 3 West Oak Stflet 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,California Lodi,Califc,4. ,- F.P.C❑. r