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FOR OFFICE USE: -- � d s /l' A 1`7--- wj --- - -------- Permit No. --- ---. APPLICATION' FOR SANITATION PERMIT � ----l- ----- ------------------ - ------_--- -------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issue ---------------------------------'------------- - „- -- Application,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application is made in complianckifthn County Ordinance No: X549. 200—0.SJOB ADDRESS AND LATI �f = "» ` CP - / -- -. Phone- Owner's Name----------; W,- ---- � Address----- - ------ --------------------- Phone_ ------------------- Phone . ------ - -Contractor's Name_., r Installation will serve: Residence. Apartment House El Commercial E] Trailer Court El Motel ❑ Other / Number of living units: /- Number of bedrooms__ Number of baths _ - -- - -- -- ---- --� --�-- ---- y Water Supply: Public system ❑ Community system ❑ Private epth to Water Table'6_, 7ft. `f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®-_-H1 rdpan_❑ i �, �' r FHA/VA: Yes °❑ Previous Application Made: {lfyes,date-----.---- ) No I�' ��e!"� Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .L, j ' (No septic tank or cesspool permitted if public sewer-is available within•204 feet-)'f Y *, Septic Tank: Distance from nearest wef�___- ------ Distance from foundation__ __ ___ Material_________________ ,� -; r No. of compartments. Size ��gid depth ---------Capacity i i �.� Com______---Distance to nearest lot line_ _ _. foundation__ ___ - '' - .�y Width of trench- -- Dis os�a�eld: N�urtnbere of I nesfrom earest.well._. Dength ofistance rea '1_=_r�----------=- ----- � -----�--� ------------ ---------------- p each line___ _ �. Type of filter material__ Depth of filter material_ --_ Total length t Seepag _ _ Distance to nearest well_____---_:___-- ___--Distance from foundation_ ________________ Distance to nearest lot line_. ----------- Number of pits....... n ----_ --Lining mateal__._1Z6 '----.Size: Diameter--- . -----Depth---`--- .d__--- -- s k Cesspool: Distance from nearest well-----------------Distance from foundation__________________.Lining material-' _--__----___--- ----------------- N Size: Diameter----- _- --- -- ----Depth------- -- ----------------------------------------Liquid Capacitygals. El ance from nearest building---------------------•------ ----------.-- ` Privy: Distance from nearest,well------- -------_-___--_ Dist ❑ - Distance to nearest lot ine__-_____.__-__-- -~-- -------------------- k j °' T - ------ c Remodeling and/or repairing (describe):_-._-___._ t .F 4� I hereby certify that 1 have prepared this application and that the,work'willbe done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' - Contrac#or r (Signed 6�"�1k'.-._ ----, BY:------------------------------ - --- -- - (Tit - - -- (Plot plan, showing size of lot, location of system in rel i to wells, buildings, etc., can be placed on reverse side). e FOR DEPARTMENT USE ONLY x DATE- "A-7-----/ --------- --------- ------------------- APPLICATION ACCEPTED BY----------- ----------- - --Gam ' --- -------------------- REVIEWED BY------------------------- ------ ----------- ---- -_: DATE_ BUILDING PERMIT ISSUED------------- ------- ' _ ----------- --- ----- DATE.--- ----- :----------�•--------- ----------i----i Alterations and/or,recommendafionss.____ -- ---I-.�' - -- �` ------------- ----------------------------------------------- ----------------- --------------- ._ -- --------------------- -------------------- ------------------------ $ . Date--------- � ............... - ---------- FINAL --- - --.FINAL INSPECTION. Y - S JOAQUIN LOCAL HEALTH DISTRICT i 1401 E.HaTalton Ave. 300 West Oak Street 124 Sycamore Street ,„ 205 West 90 6e Street�,,M. Stockton,California Lodi,California _ Manteca,California. Tracy,Caiifotnia