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FOR OFFICE USE: y ______"-._______"_-______________-___-___ ATION FOR SANITATION PERMIT Permit No. ____________ . � . -------------------------------------------------------- (Complete in Duplicate) Date Issued ----------------------------------------------- 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 inyfall the work he ein described. This application is made i�Uc ian�ce with County Ordinance No. 5449. S'Q POR_ �c JOB ADDRESS AND LOCAT►ON............CAP, DozA �hL� �R�T MA:I?ITECPC - - Owner's Name------L�ANUeL--.-. E..6-0-----------------------�--------------------,------------ ---------- Phone---L.7rl' D f!��--- Address---..........1.5- o...----1.'mfKN----Co-v-9T3-----�_L_h..._. �-------CA. ! /`7---------------------•-----.... Contractor's Name------5'A�"-F--- Phone....................... -------- Installation will serve: Residence XApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Al Number of living units: -----V Number of bedrooms Number of baths ---/--- Lot size ,� .Dl�l�.- ._f'�__.-t.------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table fft. Character of soil to a depth of 3 feet: Sand IN Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------.------) No 96,11' New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:KDiistancv ir (No septic tank or cesspool permitted if publaIbk-•w*,irm:2W4eetiSeptic Tank: Distance from nearest well__.-__-- fro foun�Jation.-. -. G�yvc'e�----------- ateri I---------- No. of compartments------- _ -----.-Size'$iIXA_X `�'_-- ---Liquid depth----4 .— Capacity..��(�.._. Dis osal Field: Distance from near�5t w ll__I�0_ _Distance from foundation.../ -_-.Distance to nearest lot Number of lines_____ ____ __ Length of each line---- .-_�-} Width of trench-- .a. . Type of filter material__/ �C�--Depth of filter material---_.--lx-_------.-Total length-__. Q.:......................•- Seepage Pit: Distance to nearest well.---------------------Distance from foundation....................Distance to nearest lot line-.-.-.-..__---._ ❑ Number of pits.--.--.---------------Lining material--------------------._.Size: Diameter_...-----------------Depth..-_.-..---..-..---..._.----.- 0 Cesspool: Distance from nearest well-----------------Distance from founda+ivre------- =---------Lining material_-__-----__-...._-.-.-----_-------- .� ❑ Size: Diameter----- --------------- ----------------Depth--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well- -------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-- ------ ----------------------- ---------- ----------------------------------•------------------------------------•-•--------------------- N Remodeling and/or repairing (describe):------------------------------------------------------------------•-----...._....-----------•-----...----------•--------•-----•------------- •------- L4 -------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------- �o I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------------------------------------------------------------------- ---------------------------------------------------------------------------------.(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------ ------------------------(Title)-------------------------------------------- ---- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ` W FOR ccDEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- l/hpit,a/1� --------------------------------- DATE---- --- REVIEWEDBY---------------------_----------------------------------------------------------------- --------------------------...... DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - - ------ D :E Alterations and/or recommendations------------------------------ ------ ----- .•-..---•---------------------------- --------------------------------------------,----------------------------- --------------- --------------- --------------------------------------- ------------- ----------------------------------------------------------- --------- ---------------------------------- ----------- --------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:------ 74 ------------------ Date L --------------------------------------------------------- SAN JOAQWN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.