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FOR OFFICE USE: ------------------------''------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. . AM ----- -------- -- b - - (Complete in Duplicate) - ---- -- - Date Issued __tr LAS_-_�� _. - This Permit Expires 1 Year From 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. 549. fin/ : p in 7 3'70—05' JOB ADDRESS AND LOC TI � 11 r.✓- aw f� ------- G- -------------------------------•-- Owner's Nam e-------P.!--- ------ ------ -------------------------------------- -------- ----- --------------------------------------- Phone------------------------------------ Address= q.7 _ .. � -�---------------------------------------------------------------------- c. t ------------- - r-------- Contractor's Name--- ----- - `" ------------------ Phone-----•------------------- - ----- ----------------------------- --------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms --4-_ Number f baths a--_ Lot size -----0; __._ ------------------------- Water Supply: Public system ❑ Community system El Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam El Adobe ❑ Hardpan ❑ Previous Application Mad (If yes,dote....................l No ❑ New Construction: Yes_❑_No.❑ _FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) Septi ank: Distance from neo est we11_40_'_- Disfance-from=foundation_/rP_*-__________-Material---.fie •�-— ------- - No. of compartments______a_Z_____---------- depth__._ft__._.__.-..._-.____Capacity_JAN ' Dispo Field: Distance from nearest well.- ---------Drstanc'e from foundation__/ ' __�,_i :_._____...Distance to neare_st_ lr_ot_line.5_____--._____ Number of lines---------2 _________ __------Length of each line---- --__ _ Widthof trench_ r________._____.___ Type of filter material______. Depth of filter lter ma#enal____.__j_I_ �__.__.__Total length....... l u�I See a Pit: Distance to nearest well----___/PO------Distance from foundation... ._lp---------Distance to nearest lot line-_-5'_'---.___-- L Number of pits--------Y.-------Lining material________SR_----- ______ ---.__ Cesspool: Distance from nearest welL________________Distance from foundation-----.--------------Lining material-----------------------._-_-________-- ❑ Size: Diameter- - ------------ - - ---- -----------Depth------------ ------------ --- -- ------------------Liquid Capacity----------------------------gals. Priv Distance from nearest we11----------------------------------- Disfance from nearest building � ❑ Distance to nearest lot line----- --------------------- --- - --- ---- - ------------------------------- ------------------------------------------------------------- Remodeling and/or repairing (describe}-------------------------------------------------------------------------------------------------------------------------------------------------------- ------------•-----•----------•--------------------------------------------------------------------------------------------------------_----_--------------------- --------- ------------------------------. i ------------- -------------------------=---------------------------------------------------- ----------------------------------------•--------------------------------------------------=--------------------- --------------------•--------------------------------------------------------------------------------- ---------------------------- ------------------------------ ------------------ 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 d rules and regulations of the San Joaquin Local-Health District. (Signed)------------------ ------- ----- and/or Contractor) gyp----------------- -f----- - ---- --------------------(Title)---------------------------- - ...........................---- - -- - - ( (Piot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). a- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- ----------------------------------------------------- DATE:... --------------------------- REVIEWEDBY---- --------------------------------------------- --------------- ---------------------------------------------------------- DATE------------------------------- BUILDING PERMIT ISSUED--------------_--- --------------- ------------------------------------------------------------- DATE,- -----------------------------`--------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------`---------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------- 1 -• ------------ ---------- -----------------------------------------------------------------------------------------•-------------------------------------------------- ------.------------------------ FINAL INSPECTION BY:_. •-�. .- •! Date-------------------------------------- F �• , ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.