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FOR OFFICE USE: /a- -""" ----------- --- ----------------------- ... APPLICATION FOR SANITATION PERMIT Permit No. ` ----------------- 7 ----- ---------- --------- (Complete in Duplicate) Date Issued ------=�-`6-A" --- ":__- .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 here-in described. This application is made in compliance with Coun Ordinance No. 549. 7 ,4p U '1i✓, i; - - Z.01- 200,33 JOB ADDRESS AND LOCATION ------------------ ----------------------------- --------- t i �°�,.__.. Phone---� '-- gra ^ ------------ "' ------------------------ - ----------------------- Owner's Name......._ ---------- Address----- 6�•-�•--------- �-``---- ., ''. ----'_-_'`_.."- "l- =----------------------------------•--------------- �.F u :el ��--------------------------------- --------------- Phone.. ` `--j- Contractor s Name.....-"��------�-�-�-,-- --"�-�--�------------- - Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Mofiel ❑ Other ❑ Number of living units: ..."._.- Number of bedrooms _-. "'Number of baths ----:;?-C size ,t Water Supply: Public system Community system [_1 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam F] Clay ❑ Adobe ©—H-ardpan ❑ Previous Application Mader (If yes,date------------------ -) No F1New Construction: Yes 9—tgo ❑ FHA/VA: Yes E] No [� TYPE OF INSTALLATION "AND SPECIFICATIONS: ,(No.septic tank or cesspool permitted if public sewer is available within 200 feet.) �_ rt.tic Tank: Distance from nearest well...- _C%�YDistan� frog f� "'�� i-� ! �' Q i Sep ounda�tion- Material = : Size ,---�5.�-'Li uid de th--------` -----------Capacity-- ��©. ❑ No. of compartments_._..... e:-- q p i f� Disposal Field: Distance from nearest well_ _Distance from faun � _----..Distance to nearest lot line----------------- -�•�-__..."- datian...". .. ❑ Number of lines------------ Length of each line-----__-_F -------------Width of trench."...��.- :_f-------------•- Type of filter material..-----lo4l LP��Depth of filter material-..... ` .-"__...."To#al length--".------1`r4?-------------------- - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------.-----------Distance to nearest lot line..--_--------..._ ❑ Numbeii r of pits---------------------Lining material-----------------------Size: Diameter.----------------- ----Depth- ----------------------------- Cesspool: Distance from nearest well----------------- from foundation Lining material-__.......__...___......--_..... ❑ Size: Diameter-------------------------------------Depth--------------------------------- - --------Liquid Capacity--------------------------gals. -��PFiV-"� Distance from"nearest well.."-----..--____..--------------------------_..-Distance from near sT building_....._ .....- Y ❑ -------------------------------- Distance to nearest of ine------ ----------------------------- t Remodeling and/or repairing {describe)-------- - ----------------------- ---------------•------------------------------ --------- --------- ---------------------------------------------------- ------------------------------- -------- ---------- {� ------- - - --- ----------- ------------- ------ --- ----------- ------------------------------------- ---------------------------------------- ----- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed). �---- -------------------------------------------------------------(Owner and/or Contractor) -- --------------------------------------(Title)----- pian, showing size of lot, location o system rn relation+56-W-6 1lsbuildings, etc.;ca7iTbe placed ors-reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE" &- -�-f'----------------- REVIEWEDBY--------------------- ---------- -------------------------------- DATE---------------------------------------------------------- - BUILDINGPERMIT ISSUED------------------------ ------------- -- DATE------------------------------------------------------------- Alterations and/or recommendations--- ------------ -------- ---- -----•--------------------------------------------------------------- ------------------------------------------------ ------------- -------------------------- --------------------------------- ----------------- ------------- ------------------------------ ---- ---------------------------------- - ---------------------------------------- ------ ---- ------------------------ l 3 / FINAL INSPECTIONW----------------------- Date----------------- ------------- -------- ----------------- SAN JOAQUIN 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 r.R.c o.