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FOROFFICEUSE: ,a C-_ J ,-_--j = -� APPLICATION FOR SANITATION PERMIT Permit No. 2Q-42--Z --------------------- ----------------------------- (Complete in Duplicate) -------.-------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein des ribed. This application is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LOC TION ( �` - ,��.y� Phone. --- ------- Owner's Name------ � >A�/- -------------------------------------------------------------------- Address.-•------ 1------- E' � --------------------------------•-•------- Contractor'sw Name____________X�r� - _ / ` _________' ------------------------ --------------- Phone-•--•--•--------------------------- Installation will serve: Residence [,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms ._ Number of baths _ -_ Lot size -Wye ___. Water Supply: Public system ❑ Community system ❑ Private 9j---D5`epth to Water Table Wft 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 21"'No ❑ FHA/VA: Yes ®—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ��jj Septic Tank: Distance from nearest well_- --�' _Distanc (rpm foundation--.,� ---------Material__��1w�,�`�_ �1 [� No. of compartments--- -----_____-__-_Size_ OW5W4AAW- iquid depth____-_�V--------------Capacity_/XA'-___-_ Disposal Field: Distance from neare�sJt well....� _Distance from foundation____�e_�__.Distance to nearest lot line_ .A____ Number of lines_____°____-� ength of each line___ ' ------- ------Width of trench--___ Type of filter material ___ _ -- Depth of filter materia--l �f j ` ` .Total lengfih �� Seepage Pit- Distance to nearest well-- ...___Distance from foundation--1 ______. istannce to nearest lot lire_ ~ Number of pits--- ------------Lining materia( __.. --.-Size: Diameter _'______________Depth,t-?-O--_ 8 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------____---_-______. ❑ Size: Diameter--------------------------- ----------Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot Line------- ------------------------------------------------------------------ -------- --------------------------------------------------------- ----------- --------------------------------------------- , Remodeling and/or repairing (describe):------- - ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --------------;--------------------- -----------------------------------•--------------------------;-------------------------------------------•-------- ----------------------------------------------------------- -------------- ----- ---- ------ ------- P ------------------------------------------------------------------------------------------------------------------------------------------ I herebycertif! -- p---- ------that I have prepared this ��pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru and regulations of the San Joaquin Local Health District. 7e� -- -- -------- - --- -- -- - �.or Contractor) By: ------- -----------------(Title) -- -- -/, L (Plot plan, showing size of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ----� �-` DATE - Z __ REVIEWEDBY------------------------------------------------------------------------------ ---------------------------------------------- DATE------ �-------------------------------------:----- y BUILDINGPERMIT ISSUED-------------------------------l----------- -----------------------t-------------- - DATE------------------------------------------------------------- Alterations and/or -- morecos mmendations:-------- F -------- =- ` :.�.-=~-------`�'-�-----� -------- � �f ------------- -- j t - ------------------------------------------------------------------------ ....... ------ - --------------------- -------------------- X� FINAL INSPECTION BY:.-- /-51 -- ---------- Date_. - ----- ----------------------------------------- AN G10AQU1N LOCAL HEALTH DISTRICT 1601 E.Hairellon Ave, 300 West Oak Street 1124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F-P.CC-