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31' �1b.- ------------------------l-�——- APPLICATION FOR SANITATION PERMIT Permit No.�,-A__f -- - --------------- ---------------- = - ------------- -- -- {Complete in Duplicate) J --------------------=------- --------- 1 Date issued ---- ---�- - This Permit Expires 1 Year From Date Issued �; a /---- 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 No. 549, JOB ADDRESS AND LOCATION___��-_— - - ----- -------------------------------- -----------_--------------- Owner's Name------- -- -- - ---------•------------------•-------•- -- _ �j -------------•-------------------- Address C;J�"fc.G ---------- ---------------------------------------- g --------------••--------------- - Contractor's Name____ - � - -------- --------•---- Phone-------------------------••------- Installa#ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _�4 Number of baths --_/_ Lot size Water Supply: Public system ❑ Comm unity system ❑ Private Depth to Water Table4ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sarl Loam CClaY Loam El Clay ❑ Adobe E"-H'ardpan ❑ Previous Application Made: (If yes,date_..___._°..___....._) No Construction: Yes R?"l d FHA/VA: Yes ❑ No.[E- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public/ewer.4s ova labF within 200 feet.) 1' Septic T"nk: Distance from nearest'� ,wel!__�---.._-pistance fr m';fpur�lation_,�4__---------- ---- _____ _. No. of compartments___---- -_---.-----Sixe -�(� Liquid depth-____ .-_-.- I ___.___Capacity_/ -Il Disposal ieid: Distance from nearest well--_151 - `Distance from fours7frion___�d�_�---- .Distance to nearest lot line ' --- -,r Number of lines--------- '------,- - -Length of each�line_'j��_-�Q- ---.Width of french-- lee;material-s�ls _ « /Depth:.of filter materral____- �'----- -__--Total length____,_,l 0 Pit: Distance to nearest well- {_ !_Distance,from foundation___..___ Distance to nearest lot line_____ ❑ Number of pits 4 _ 3 g`Lining'mate`rial---- --`--� -,-- "Size: DiamEter. - Depth � . Cesspool: Distance from nearestYwellw;_' _ i_Dista.nce from foundation____________________Lining 'material_____- D El s 9 _ ------ -- ----- Size: Diameter._---- ---- ----Liquid Capacity----- ----- ------ --------gals. - --- Depth -------------- '�- Privy: Distance from nearest well ;wk =_-- is - building - 7------------------------------------------ \ ❑ Distance to nearest lot line--------------t__-----fflll - `- �,, f-- + -- --------------------- Remodeling and/or repairing (describe) ' 11 tt t ----------------------------- -------`-- r _:: - -- - ----------------- _________________ -----------_--------------_-------------------------_------------------------------------------------- _____________________________,______________________ _ _____________________________________________ ____.______.._ ---------_________________________________ _____________________________ __ a--------------------------------------------------------------- _-------------------- ________ 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) -- -- _.. ------- ----------------- ---(o----------------------------- By:------------------------------------------------•- -- - caner and/or Contractor) -------------- -------{Title)----------.---- # (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....._- x DATE--------- BUILDING PERMIT ISSUED ----------------------------------------------- REVIEWED BY------ -- ---------- ------------- -------�----- ------ DAT ----------- - - E---- --------------------------- ---------- ----------------- ------------------- Alter #ions and/or redoDATE----------------- ------------------------------------------- ------------------------------------------------------------ ------ ------- FINAL lNSPECTION BY:------- - r T- -----• ---------- -- - ---- Date----- 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 r.p,CO. Tracy,California �'