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rUK Urri�. UbM- ------------ ------------------------------------------- _ - ---------------------------------------------.----------- APPLICATION FOR SANITATION PERMIT Permit No. RZ�l - ------------- ------------------- --------------------- — (Complete in Duplicate) This Permit Expires 1'Year From Date Issued Date Issued _ _- �✓_i� Applicat2a5--- d0-70 ^2.6 ion is hereby made #o 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. 54SC_r JOB ADDRESS'AN LOCATION_, - -- ---------------------------------------------- Owner's Name--- - - - -------------------------------- -- --------------- Phone . Address----------------------------- .-•------•--- ..��.. `` ---------- ---•- Contractor's Name------- -- -- .. -,--- ----- ---------------------- Phone__'- �- _-- -. . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer C ��o��urt E] Motel p Other [� Number of living units: -------- Number of bedrooms -------- Number of bathsao�size ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table.____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: (If yes,date __.-) No ❑ New Construction: Yes eNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ _ .ya'i _. {Na sip#ic tank or cesspool permitted if publicc sewer-seweravailable wi#hitt 27- - et} -'�"'� '�_Y �~- r Septic Ta}r k: Distance from nearest well_.a�h __-_Distance from foundation---- _Q.__--_-.Material__ -41-1-14— -. Eff/ � No. of compartments_. _ 77 , Size_3.XS -�____-___Liquid depth_.. ------------ ------ Disposal Field: Distance from nearest wellt`1 .____Distance from foundation;�j� .______-Distance to nearest lot line---- , Number of lines___.__ _ __ __ Length of each line_,3>ri___________ ----___Width of french--- a_� r Type of filter material___--z _._____ __Depth of filter material__- - --------Total length------------------------ Q----.---- Seepage P' -: Distance to nearest well-/B` __________Distan e m undationfC7a_._..__..Distan�e to nearest lot lines__ 'Number of pits._.__.__-------Lining material ._Size: Diameter----. -___.._.__Depth_,o'?0.' S Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material______._.___._._________..___..-_-_ ❑ Size: Diameter Depth -------------Liquid Capacity---------------------- -----gals. , Privy: Distance from nearest-well-------------------------------------------------Distance from nearest building_----------------------------------------. 0 ❑ Distance to nearest lot line_________________________________________________ ____________ ------------------------------------------------------------------------------- Remodelingand/or repairing (describe)-----------------------------------------------------•------------------------------------------------------------------------------- -----------------------------------------------------------------------------•------------------------------------- ------------------------------------------------ --------------------------------- -------------------- n -----------------------------------------------------------•-----------------------------------------------------••------------------------------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws and rules And r guiations of the an Joaquin Local Health District. (Signed) - -- - ------------ ---------------- -- ------ ----- --------------------------------------------------------- -------(Owner and/or Contractor) '_ _ Title _ �- (Piot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. L: .-®------------------------------------------------------------------------- DATE------ REVIEWEDE - S -- E ---- -- ------------------------------------------------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED - ---------- - ----- -------- ---------•--------------------------------------- DA•TE----------------------------------------------------------- Alterations and/or recommendations----------------------- ------------ -----------------------------------------------•------------------------ -----------•- -•---------------- --------------------------------- - - ------ -------------------•--------------- FINAL INSPECTIO Date---------- -- .r'. -----f7�ds SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 1 y 205 West 9tF,Street Stocklan,California Lodi,California Manteca,California Tracy,California r.a.co.