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rUlt Ul-H : Ust: _ ___ ------------- ____.______..__...___.._._______---- APPLICATION FOR, SANITATION PERMIT Permit No. ..c _. _,��_ (Complete in Duplicate) ---------------_._._._ This Perrf it` x ices 1 Year From Date Issued 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 C it Ordinance No. 549._.,W s , �. Q JOB ADDRESS AND LOCAT O _SIDS. Y C 00--17HLO -D---- -- ." L� 17 5"r111I �^1 L V Owner's Name------------- ._ -- -- --`� --••--•---------------------------- --------------------- ---------------. Phone--------------------- ------------ .Address----------------- (-- --- ------------M rc --`------------------------------------------------ S ----------- hone--a7 P -- � ---------- .Contractor's Name__.--14L-�--F,-•---- --�-��_..-.T�_��:-••----•------------- - -- -----------------------•------• - I Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F Number of living units: __�___._ Number of bedrooms 3-_._ Number of.baths _ Lot size __!7_ _ h}_ _ __--_____--______.______ Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table b2 ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_...______-----------) No E?"New Construction: Yes 2T14o ❑ FHA/VA: Yes Rr' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I _ No se tic Tank o� cess ool ermifted-if ubiic-sewer is-availa6le within-200 feet:�-�- —�-= — — � P �:.—_. . p Septic T Distance from nearest wel��--__._Distance from foundatin JO_-------- _ _. -------- No. of compartments Liquid de th"____________ _______"O.Capacity_.__A5___00._-_ �y I �V Disposal field: Distance from nearest well___5-0----- from foundation___1_0_.____.___.Distance to nearest lot linei_S7------ q N1 Number of lines_____•__-7?�7=..__--______--__Length of each line--- QQ------------------Width of trench------zy.______. 1 Type of filter material--- C3YZ-__Depth of filter material-----(_------------Total length-------__________2 _ --------- k Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line--.-------------- C ❑ Number:ofits________________ P ----- Lining material----------------------.Size: Diametei-----------------------Depth------------------ ---- ------- Cesspool: pistarcek from nearest well----------------- from foundation--------------0---__Lining material--------------------'----------------- --- I' ❑ Size: Diameter----------------------------------- Depth-------- -----------------------------------Liquid Capacity----------------- �- L. Privy: Distance from nearest well------------------------------------------ -----Distance from nearest building_---------•----------------------- ❑ Distance to nearest lot line--.---------------------- -- ----------------------------------------------------------------------------- ...- -------------------------------------------------- ------------------------------------------------------------- --------- ----------------------------------------------------------------------- ---------------- Remodehn and/or repairing (describe):-------------------------- ------------------- -- ---- --------------- -------------------•------------------------------------------------------- ---------------------------- --------------------------------------------------------•---------------------------------•-----------•--------- ..._.---•------- ------------------------------------------------ ----------------------- ------------------------------------------------------------ ---------------•--•----•-----------------------____________________________________-_______________________-___-__-________-______ - 4� 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 and regulations of the San Joaquin Local Health District. (Signed} J ---- - ------------------------------- ------------ ----------- --(Owner and/or Contractor) r Plof Ian, showing size of lot, location of system in relation to wells, buildings, etc., .�rtle` ( -------------------------------------------- "----,------ ( p g y g , can 6e placed on reverse side). FOR DEP MENT USE ONLY APPLICATION ACCEPTED BY------- Z '- REVIEWEDBY----- ------- --------------------------- -- --------------------------------- --------------------------------------------- DATE---•- -------------•------------ BUILDINGPERMIT ISSUED------------------------------------------------------------•---------------------------- ------ DATE-------------------------------f----------------_------------ Aiterations and/or recommendafions:----------------- -----------.---------------- ------------------------------------•---------•----•--------••----------------------------------------------- ----------------------------------------------------------------- --- ------------------I-------------------------------------------------- --------------------------------------------- --------------------------------- FINAL INSP CTION -- ---- ------ Date-------- j. b ---------- --------------- -------- i C . 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,.Cdliforniax. ..s I