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� OOFFICE: � S-- -- ----------------------- ----------'--_------_---I�-- APPLICATION FOR SANITATION PERMIT Permit No. .1_y_ �f_-_---- - --------------------------------------------------- -- (Complete in Duplicate) Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made 40--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 No. 549. �I JOBADDRESS AND ---------- --------------------------------------•--------------------------- Owner's Name------ --5- .�4 -J ------•-----------•------------------------------------------------------------------ Phone------------------------------------ } Address-- � 4/e - -' - - -------------- T Contractor's Name Q '--- -------------------------------------------------------------- Phone-----•-•-- Installation will serve: Residence Apartment House ❑ Com4mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _� Number of bedrooms _v_w_t___ Number of baths *R---- Lot size Jd -_________.____.__.___.._ Water Supply: Public system 9� Communify system ❑ Private ❑ Depth to Water Table, - f Cha'racfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑^ C{ay Loam ❑- Clay ❑ Adobe 9111Hfardpan ❑ Previous Application Made: [if yes,date____________________)' No 2", New Construction: Yes ❑ No EP�FHA/VA: Yes ❑ No kg- - TYPE OF INSTALLATION AND SPECIFICATIONS: 1 t ),j i (No septic tank or cesspool p' miffed if public sewer is available within 200'feet. . I � � h Septic T� Distance �rom nearest well________________Distance from xfound foundation---------------- Material._,Material---------------.-------------------- -- j 5 �No. of`compartments � - Size ------------------'-------Liquid depth---------- ------------.-Capacity----------------------- I Disposal Field, Distance from nearest well............._Distance from foundation----------------- to nearest lot line----------------- Number o tT . f lines-------------------------------- - Lengfh breach line- i- -------------- - -,--- Width of.trench-------------- - V ype of filter material-------------------------Depth of filter material----------------------- length---------------------------------------_-- Seepage Pit: Distance:ito nearest well.... -------Distan rom a ndati ______.Dist Dista-rice to nearest lot l�e__s .__f_. Number of Its_____ Linin mate L- 1- -_Size Diameter-__&r p g p , Cesspool- fl�tfahceajfrom nearest well____.____._____-Distan dation------------------_Lining material--------------------------_-______._. " ------------------------------ -------------I--._Li Liquid Capacity ❑ � i �frotmr nearest well------------- -.Depth ------- -- -----�-----#---- k q --'-------------------------gals. Privy: i � Size: Dla � a Distance�y ________________________________Distance from nearest building_____..__.______.____________...___._._._. ❑ Dlstance'4o nearest lot line-•---------------------- - A---- ------I-- ---------------- ------------------------------------------------------------------/�Remodeling and%or repairing (describe):--------- ----------1 �_ - ---_- --------------------------------------------------------� ..�, a, ...' _ - � ...;... , ------•--------------------- =---------------I---------------------------- --�----------------------•------ ------- - ------._ ----------------------------- ------------- ---------------- -- ------------------------------ _ ------------ ------?--------------------------------------------------------------- -------------------------------------._._.----------------------------------_------__-------_-.__-.-_- ! I hereby certify that I have prepared thislappiication and that the work will be done in accordance with'San Joaquin County ordinances, State laws, and ruleslancl regulaf ns of the San Joaquin Local Health District. (Signed)------••--------- ` --- ------ ----------- --- - --- --------- - ---- --- ---- -------------------- By:__ ------------------ - �r Contractors I By:_ ------------ ----------=---- '----------------------------------------=_- - -- ----- ' -----(Title)- ............ ------------ (Plot plan, showing size of lot', location of system in relati o wells, buildings, etc., can be placed on reverse side). j� FOR DEPARTMENT USE ONLY 001. _ APPLICATION ACCEPTED BY-- ---------------------------------------- DATE 4� 7 �' ---- REVIEWED BY---------#-- -------- ------------------------------------------------- DATE ------------------------------------------ ------------------------------------------------------------ -i-- PERMITISSUED--�f'----------------------------------------------------' TE------------------------------------------ ----------- 11 and/or recommendations: � � --.U-Gr y ----------- ----------------I------------- ------------------- ------------------------------------------------------------------------------------•--••--------------------- ----------------------------------------- i I - - -• •----------- ----------- M --------------------------------------------------------------------------------------------- - ------ -------------------- ----------------------------- ...................... . ....... -- -- --- l- ---------------------- ------------------- ----------- FINAL INSPECTION BY:.-`----......._� -------------------- Date....------ � ----- - ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. l 300 West Oak Street { 124 Sycamore Street 20'5 West 9th Sheet' ,�• ' I aw gv. - Stockton,California II lorli=Califomia +; + Manteca:Caforn ia Tracy,California i