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FOR OFFICE USE: - ----------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . Ta..l�.��_....� - ------------------------------------ --------- -- -- -- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From 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 County Ordinance No. 549.1"3jp^S: T JOB ADDRESS AND LOCATION_..._ Gl1 / _ ._ __. .P- G6Pa9�1 .._.._.... .. /+ ? S.......-.. 5.4-of Owner's Name._ 2`?.' --._ _ .. _ .�1�4. a A\ .----' ---- ---- --- Phone.- -- --- ------- -- � Address-........ r.� Contractor's Name �� .4 -s L�l'�5 .. t�P � �/ -�- -----= Phone.... G:�--`•�-O- �. Installation will serve: Residue s�n��° 3 ApA'T•#ment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ Number of bedrooms . Number of baths .... Losize Number of living units: _1 „�_ r / ' Water,,5up�ly.: Eubl`c\systemM�TltCGom `14itysyystem ElPrivate Depth to Water Tale ... _ ft. Character%of-soil to a depth of 3 feet: Sand❑ -Gravel ❑ Sandy Loam Clay Loam ❑ Cla�FHA/VA�Yes Adobe,❑ Hardpan ❑ Previous Application,Made: ('If yes,date....... .6'..) No '""Nee Construction: Yes N] No ❑ No TYPE OF{1NSTALLAT,ION'AN D'ZPECiF[CATtIO (No septic tank or ces�spoof p�rmitted if�public �wer,is available within 200 feet.) Septic Tank: Distance from Jest we i Distance from foundation.....�0._..__.. a'erial_._ /�C .fT.._ r�' No. of compartme�nts _ _..� __..r_Size.__1ZLt?Qquid dept...... �-._----.Capacity �t9�.�✓ Disposal Field: Distance f�romoneaesit we I�, Q___._Distance from fOSr 19,06-4601.Liquid ... ..� Distar�CeXt`o nearest lot line_/�_.._..___._ Numberg _-Length of each line..// �_____ �f lines_._--__- (,e _�___Z_ Width of trench------� --- - Typb of filter mat rial__ _--_Depth of filter material--_._.f .....Total length......... --.--.-_--_.-_.__ Seepage Pit:e00001Distan�to nearest well.................-----Distance from foundation-__.-_--_----___.Dista nce o n ea rest lot line......-_-------- ❑ /Number of pits--_...................Lining material-_------- ---------- Size: Diameter.---•------ �ptli--------------------------------- i Cesspool: -O Distance from nearest well.................Distance from foundation.......... _,____.•Lining mate`raaf: ._....._....._..... ................ El Size: Diameter--- ----------- ----------------------Depth--.-...................................<'—C uia�C'a p aci ty.ttV\ gals.l "Privy: Distance"from ea�est well-_ . .-'___...._.-.._.---....__..Distance from nearest building_...._ .....a....... ...... ❑ Distance to nearest lot line------ ----------------. -- --- ----- Ax-----------".._---------------------------------- ------------•--•-- - .......... Remodeling and/or repairipq (describe):- V,1,1. ' 1'o ,C1... 04 oo. ,Gf� r1 t�, �..__!!lJs .fl--/!.SQA-----, ..-.. G/ _.�--------------- = ... -- 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. --.'---- .-� ...._._...._....--- - ---.--.----• Owner and/or Contractor (Signed) l/' ------ /... _.fd { / ) 1 BY --...-•--••------(Title}---' ..•-•--'-•.-•...........:... (Plot plan, showing si a of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.. ---'- --------------------------------------------------------------- DATE----------------- ................................. REVIEWEDBY--------------------- ------------------------------ --------------------------------------------- - - ) � DATE----- ::r<,e ��-...-------------------------•--- BUILDING PERMIT ISSUED. --------------------------------------------- `. . ---•- DA ........ -------- ........................................... BUILDING and/or recommendations:-------..--••----------•-------------------------------------------------------------------................................................................... ------------- --------•-•---•----•----------------•-•----------• --•---------------- - ----------------------•----•--•--•--------------------•------........................................................................ ............................................... ............................... ......................................................................................... ------••---•------------------------------- .....-•....................................•---••---•----........--•---.....------ ---------- ----------•-•-----•----•---------------------.------------------------------------------•------------------ --------. ------- ------------- --'---..............---•----........._._......... -------------------------------•-•-----.....-..-----•-----.-----.-......... FINAL INSPECTION BY:.......... ........ /� ------------`�` °'---•--' •---- 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 Tracy,California F.P.CC.