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OR OFFICE USE: 7 ------ APPLICATION FOR SANITATION PERMIT Permit No. 7 --------------------------""---- (Complete in Duplicate) Date Issued -----7/ ----------- _._-_- This Permit Expires i 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 N . 549. � AND LOCATION-------- d �. 'I ---------•----------------------------- •------------- ------------------ J08 ADDRESS A� •e /v Phone------------------------------------ Owner's Name------- - --_ ; ---� .' - - Address----------- 11 = Contractor's Name C-- +- ------------------------------------ --------------------------------------I Ph'one..........------------------------- r Installation will serve: ResidencermNum Apartment House'❑ Commercial ❑ Trailer Court ❑ _Motel ❑ Other ❑ i # ' ''��{ X---f ---- Number of living units: !.- r of bedrooms =Number of baths _�""_ Lot size _"; Water Supply: Public- system ommunity system ❑ Private ❑ Depth to Water Table -7ft. Character of soil to a depthaof 3 feet: Sand ❑ Gravel ❑ Sand am ❑ Clay Loam ❑ Clay ❑ Adobe�l�ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No [��HA/VA-.:Yes ❑ No ) TYPE OF INSTALLATION AND SPECIFICATIONS: y _ '• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .A Septic Tan Distance from nearest well_--.------___Distance from foundation--. _ -MateriaL4e"�A_ --------------- ` pp.. No. of compartments--.. s� _-.Size3-d _ _ - Liquid depth""" -----------Capacity"O.__�C __"""-•-. Disposal F' Distance from nearest well....-� -.-Distance from foundatiorl`. j----Distance to nearest lot line-- _-"".""" Number of lines-------/------- ---- --Length of each line__,F ----------� --�--Width of trench..A ----------------- ------ AOF lengthd T_YPe of filter material-"� Depth of filter ma ----j�" ' -._.___""D�stance from foundation""_/fes..---- Distancto nearest lot lit- W Seepage P . Distance to nearest well__--------`� Number of its---. ._ Linin mate ria l._-, 11 �'.-- Size: Diameter-. r3 _ ' Depth- � __ �/ � Cesspool: Distance from nearest well-----------------Distance from foundation-.- -----___.--.- - Lining material---`-----..------___-.-------------. O ❑ Size: Diameter--------------------------------------Depth---------------------- Liquid Capacity gals. Privy: Distance from nearest well--------------------- ----Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line.----------- -------------------------------------------- ---------------- ---------------- 1 r Remodeling and/or repairing (describe):----------- ------- ------------------------------------- ---- r ------------------------------------------ - - -------------------------------------------------------------------------------------------- ----------------------------------------------------------- -------------- k 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, and rules an regulations of the San Joaquin Local Health District, t ., ---------#---(fDy�rontractor) (Signed)----------- ----------- --- ---- ----- ---- -- ---- - - I----- -----------M `' (Title)".. t��,�-- —------------------- ----------- (Plot plan, showing size of lot, location of system in rel a+ion t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- =----- DATE ----------------- ------------------------------------------------------------ ---------- REVIEWEDBY--------------------------------------------------- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- --------------- DATE-------------------------------------------- --------------- Alterations an//or recomesx�n at}ons- �. ---r-�•r�-- ------------------------------------------------------------------------------------------------------- ------ -----7�.�L" Spa._"--------- --- ------------ "--'-----------------4 - -J---------------------------------------------------------------------------:--------------------------------------• FINAL INSPECTION,.BY.;-------- � --------------- Date { 'S-- --- ------------------------------- "`"'� f � SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak.Street ,�124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California a ; +Manteca, California Tracy,California F.P.0 O.