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FOR OFFICE USE: --- -------------- - APPLICATION-FOR SANITATION PERMIT Permit No./.�IJ-!•-�--- ----------- -------- ----- -------- -------- (Completelicate) Date Issued -J��f ----------------- This Permit Ex ires ea om Date Issued Application is hereby made to the San Joaquin Local Health Di or a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 177- JOB ADDRESS AND LO ATI N------ Phone- -------------Owners Name------- --------------------------------- --- ----------------------------------- Address--------- - --- ---/ W "---------------------------------------------------------•----------------- Contractor's Name------------- .11� � r Phone ------ - ------- - ------------- ------------- -------------- Other Installation will serve: Residence �'Apartmen# House El Commercial E] Trailer Court ❑ Motel ❑ drooms-umber of baths A-- Lot size ---001A/-- --------------------------------- Number of living units: - -- Number of be Water Supply: Public system ❑ Community system ❑ Private 9?"IDepth to Water Tableft. E ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No New Construction: Yes ®-"N-o ❑ FHA/VA: Yes ®/'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr we _-- - --'--Dista.c�from founndation--. �_----.Material _. / --/;ZBO No. of compartments------ Siz��IN tion depth-----�` Capacity. --- ----- -- --- Disposal Field: Distance from nearest well..'460-.------Distance from founclatio -- -- --------- Distance to nearest loft line-- - ------ -f- --.Width of trench- J Number of lines___--- ____- Length of each line_-- ------------------------- Type of filter material s Depth of filter material ---_ ----.-Total length_-_ ,��----------------------- -� Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line.-__---.-----...- (V ❑ Number of pits......... --- Lining material---------- size: Diameter-------------- ------Depth--------------------------------- ------- Distance from nearest well-----------------Distance from foundation-----------------__Lining material----..------------------.----.-------. ❑ Size: Diameter---------------- ----------- ------- -Depth----------------------------------------- - --------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well'--'-.------. _-_-------------------Distance from nearest building---------------------------------- ❑ ------ r Distance to nearest lot line------ ------------------------------ -- ------------------------------- Remodeling and/or repairing (describe):------------- , -------------------------------------- i --------------------------------------------------------- -------------------------------- .: ------•----------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this pl' ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg an Joa uin Loc _Health District. --( or Contractor) ------ - - - -- --- -------- ---- (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY Z 6,sr APPLICATION ACCEPTED BY_. ` ----.- DATE -------------- -------------------------------- REVIEWEDBY-------------------------------- ----- ------------------' DATE BUILDING PERMIT ISSUED-------------------=-------- DATE ----------------------------------------------_------ Alterations and/or recommendations:-------------- -------- ------------------------------------•------------•----------------------------------------------- -------------------------------------------------------------- '� --------------------------------- I -------------------------------------------- --- ---------- ------------------------------------------------- ------------------- -------- ------ - - -- ------------ --- ---------- ------------ - ------•------------ ---------- ------ ---------------------------------•--- FINAL INSPECTION BY: - { Date--- - - r- - SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.