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r-UKUri-K-E USE. _�_ __ .. �. ------ ------------------------------------- --------------- ------- ----------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. _..1 45 d-- --------------------- -- ----------- -------------------- (Complete in Duplicatel This Permit Expires 1 Year From Date Issued Hate 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 Ordi nce o. JOB ADDRESS Q L — --- -- - - - ----- --- Owner's me------ _ - --- - --- -- } ------ P on 1 �d - ---------------- - Addres -- - r -Q - ---- -- ------- Contractor's Nam _ f --- Phone. - - _ ' ---- l Installation will serve: Residence [�partment House El Commercial El Trailer Court ❑•' Motel El Other '�.--------•------ Number of living units: __j---- Number of bedrooms.. umber of baths _ ---- Lot size -----.�.. _�" • 4 / ) Water Supply: Public system ❑ Community system Private El Depth to 'afar Table _:------ ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------- _--- No ❑ New Construction: Yes [ 10 ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic lank oo essp`ool permifte`d if public sewer is available within`200 feet;)`"' Septic Tan Distance from nearest well_1 _-"Distance fromo nd i !r il►L lf ____..Mate rial_etp__�77------No, of compartments----- __ -Siz7l- e --- - -• ---� -- uid depth ---�--Ca acif __ DD- � P Y � ' Disposal F' Id: Distance from n t weIL.0 ✓"._.Distance from foundation-"-./.p�-.".D�i Ince to nearest lot line..___ p Number of lines --_-Length of each line.-_+ �- ,1�*. •Width of frenchpe- ; _- -_.Ty _of-filtermaferi (` epoffier,material-----� r --"Total length-----�I"( _ -------- Seepage Pit: `"N_V Distance to neatest well. ... .... .... ...Distance from foundation--------------------Distance to nearest lot line---- ❑ )� Number of pits------------------- Lining material------------- ----Size: Diameter_ Depth_ - Cesspool: Distance from neares# weft-------- from foundation--------------------Lining maferial..___.----"_-____.._ - ; ❑ ` ---- II Size: Diameter-- - ---------------------- -------Depth---------------------------------------------------Liquid Capacity gals Privy: t Distance from nearest well Distance from nearest:building-------- "-------------------------- --- El l: Distance to nearest lot line----- - _...______-""_"-----_ -----------i------------------------------ Remodeling"and/or repairing (describo):__.__________________ t F t ---------- ------- i - f �. rr► l' F_ ________________________------------------------------------------------..-.._.----------------- I here6 coH' 'tha I,have k 'c ----------------------- ----------------------------------------Y y prepared this application{and'+hat the work will 6e done in accordance with San Joaquin County $ ordinances, St a ws, n rules and(re lations of the San Joaquin L ealth Distric+. __A `. (Signed) - 14 9 --_ - - • t Y - - = Con+ractorj t BY= -------------- ---------- �------�---y ----- --- .=�------ - ---- ---------------------- (Title)-' (Piot plan. showing.size of.lot, location of system in r tion to wells, buil ngs, etc., can 6e placed on reverse side). ( FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY_-,---7.;-�� 0------------------------------------------------------------ ---------------- REVIEWED BY-------------------------------- - -- - ------------------- UILDING PERMIT ISSUED-------------------------------------------------------------- Alterations and/or recommendations::_'__.- ------------- ------------ ---"----------------------------------- ---- { ---- -------------- ----------- -- ------------- - ----------------------------- ---- - ---- - ------- ° FINAL INSPECT Date-- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California F.P.CO.