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�- FOR OFFICE USE: aQQ -------------- -------------- -----=- - ---------- ................. ................. APPLICATION FOR, SANITATION PERMIT Permit No. _9�Q. Com lete in Duplicate)-- -- - ----- ` ( P P ) Date Issued �?`~ , ------ -=-------------------------------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. t This application is made in compliance with County Ordinanc a. 549. ---------------- JOB ADDRESS AND LOCATION....__.../� p Owners Name-. .. ]- ! r - -� w . � --------------- #------ --------- ----- -'Phone--.' : ' r ------ �-- 1--. A 1- 5 ----- Phone . ..- ..-... Contractor's Name.............. r�� i rT Installation will serve: Residence$ Apartment }louse ❑ Commercial �❑ Trailer Court ❑ Motel ❑ Other ❑ Numbers of living units: -1___.N Number of bedrooms IS--- Number,of baths - Lot size �� ...Zpa---�_---_--_____.__.__- s I I __ -_.._ � I I Water Supply; Public}system ❑ Community system A Private ❑ Depth to Water Table ft. Character of Soil to a"depth of 3,feet: Sand ❑ Gravel ❑ Sandy Lo#t❑ ClayLoam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) N6;4New Construction: Yes ❑ Not9f FNA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Jan(or cesspool-permitted-if pu6lic,sewer is-available ithin.200_fee#,.]. _ : Septic Tank: Distance from nearest well-- --------------Distance from foundation---- Material--.___-.._-....__.-_...-.-..-._-.......__..._.. ! EAV5- 1kf NO. compartments--------- - --- I I - �. d Pth�------------ ------- Capacity--------------- -s-- ------Size----------------- ----- --- - - Liquid q Disposal Field: Distance from nearest well-- dg-7-Distance from foundation- .....-.....!Distance to nearest lotline-2-0...._��, i Number of lines... ; ; £ — -------_Length of each line_._.. ....$. -_.-..°.Width of trencil.. ._..- .x � -------------------- Type offilter material--ZZ ,....Depth of filter material___.. "_ -Total length-------- ----- ..-..--.- C��t_.--: Distanfcje to nearest lot line X219 x Seepage Pit: Distance to nearest weli..:�l_D� -_Distanc",om ndation. _- Jry Number'`of pits. . ' �Lining material.. -Size: Diameter_33........__Depth..-„ ----------------- N Cesspool: Distance from nearest well-----------------Distance from found ion_`_.__'..... -_-.Lining material-_-........._......._.-.-.__--......s ❑ Size: Diameter------- ------------------- Depth - Liquid Capacity - -----gals. rPrivy: Distance',from-neo st.well-.__._.._..-- --------------------4 D ista n ce.f rom,,nea rest building-----_.---_______-------..._ ❑ Distance to neares0ot line----------------- �_- __ __ Remodelingand or repairing describ :-------- --- --- -----�------- ---- ------------------------------ - ---------- -- - 0- --- ---•---_---------- -- ---------}:`�.�. I / rigs ) II --------- --------------------=---------------------------------------- -------- --------------------------------------------------------------------------------------------- ------------------------------ --------0------------------------------- ----------------- �. . - --------------------------------- ------ ------------ ---------G 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County] ordinances, Stat s, an ru and regulations'of the San Joaquin Local Health District. (Signed)----------- --------- -------;;------fes �ti----1 "" 1,-- - -- -- --------- �.N ----- ----(Owner and/or Contractor) (Plot plan, showing size of iot, location of system in relation to w s, buildin s, etc.,can(b'edace reverse side). 1 , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED '$Y --- --------------------------------------------- DATE-------------1 REVIEWEDBY----- ------------------_- -------------- ------------ --- j---------------------------------------------. DATE-------------------- BUILDINGPERMIT ISSUED-=-------------------------------------------------------------------------------------------------. DATE Alterations and/or recommendations------------------------------ ------------------------------------------------------------ --------------- FINAL INSPECTION BY: 4 ---- ---------------------------- Date...----------- ---- --• 2 {` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lad!,California Manteca,California Tracy, California F.P.Ca.