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FOR OFFICE USE: � . 3,7 APPLICATION; FOR SANITATION PERMIT Permit No. - ------------ --j-4 ---.-�-- -------------- ----- ------------------ - in Duplicate)_�= � ------------------* ' ------ - (Complete P ) Date Issued - ---------- -- -- _-----------------_.. .._ This Permit Ex fres 1 Year From Date Issued ------ Appl-i-cation 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. S49. - ----------------------------- JOB ADDRESS AND LOCATION----------- ®� G�`1Y Owner's Name-------------------h'aGd/-,j ------- ---- --------------- -------------- ------ Phone ----••------------------------ -•--- --- ------- Address--•----------------------- -7 Contractor's Name--------- - /1/_<1--------------------------•--------------------- _ __ Installation will serve: Residence Apartment House F1Commercial ❑ Trailer Court El Motel ❑ Other E] �__ Number of bedrooms .--, Number of baths _ -- Lot size ______ D ------------------ Number of living units: __ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand E] Gravel ElSandy Loam ❑ Ciay Loam []Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----_-------------) No ©Flew Construction: Yes ❑ No ❑ A/VA. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] i ,rW 1. _Distance from foundation___ � �� Septic T stance from nearest well----^-� ------------ E I �A o. of compartments--------off---------- Size-- _K ��'- ---_Liquid depth----`1 ------...Capacity. Q Disposal Field- Distance from nearest well------."....._Distance from foundation_/ --- to nearest lot line_ --. f/ Length of each line-____!�Q _____________Width of trench.___-- - --- � � Number of lines-----------.��-- ---------- -- 9 - -- �� Q _-Total length___---- _ ---- Type of filter material-____.��-Depth of filter matenal____,��___--� � ,1 - ---- - earest lot line-- --------- Seepage d--_ See a e PDistance to nearest well---_-.._---------Distance frfoundation----_3P_-------Distance to n Number of pits----------/------•--Lining material__---. Diameter----0- ----Dept h-----� ------------_- 13 Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------------------- gals. r) F1Size. Diameter----------------------- ---------------Depth-------- ----------------------------- -------------Liquid Capacity---------------------------9 Privy: Distance from nearest well _-----------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------- ------------------------ -------------------------------- -- --------------------- Remodeling and repairing (describe):__---_-- --- � ----- l` � - -e 4 ------ ----------------------------------------------------- -- ---- j ------------- -- ------------- -------------------------------- --------------------------------------------- ------------------------------------------------------------------------------ ------------------ - - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I rules and regulations of the San Joaquin Local Health District. / --- (Signed) J - ner d/or Contractor) ----------------- - B , ---------------------{Title} ' Y --- --- ------ - -- -- -- --------------- ----------- [Plot plan, showing size of lot, Iota+ion of system in rela+ion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- DATE----------------------� '.�= ` ---------- --------- ----------------------------------------------- REVIEWED BY------------------------ - ----- -- DATE - -- ------------------------------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- -------- -------------- ------------------------------------ DATE----------------------------------------------------------- Alterations and/or r o id .merations--- -------------- - -------------- ---------------------------------------•--------------------------------------------- -------------------------------------- --------------------------------------------- ------------------------ ----- -------- -- fi ' - --------------------- --- - ----------------------- --- --------- ----- FINAL INSPECTION BY--- -------- ----"------------ ------------- ------------- Date...-- = - ��` -------- ---- ------------- --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California