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�- FICE USE: ------------------ . ------- APPLICATION FOR SANITATION PERMIT Permit No. .... ...... - ------ - - ------ (ComplefGttgn Duplicate) -------- -------------------- -- -------- ----------- ----------------------------- -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a perm4foconuctand install the work herein described. This application is m de in�compliance with County O inance N 549. 6tJOB ADDRESS AND C{CAT QN__;____ -_-gllg Of—, --- --- - ----------- ;� Owner's Name------- --- ------ - - - t ------ Phone- Address-------------------- hone_Address-------------------- L - k -------------------------------------------- Contractor's Nam _ k / 11 - ---•-- ------------ --------- �'„ - -�- �, _ _ ____f__ .... - --------------- hone__ 46- ._ ( Installation will serve: Residence partm'ent House ❑ Commercial Trail r 1C.urt Motel ' q F `A ❑ ❑ Other ❑ Ib n Number of living units: _1--__. umb r. .bedrooms _.Ce__ Number of baths ---�-! }.of size ' 0 _ PIG-------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table•460ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loom ❑ Clay Loam [] Clay ❑ Adobe�rdpan ❑ Previous Application Made (If yes,date_.t9_6pIj----) No ❑ New Construction:'Ye ¢[j4;<o ❑ FHA/VA: Yes ❑ No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is availabltr within 200 feet.) 11. dop tic' Distance from nearest well:.NOlI�0-Disfance from foundation____10---------Material .__________________________________ __ _ Noof ompartments-.----- -------Size-----•--•------------ __----Liquid depth_------------------------Capacity------ ------ Disposal Field: Distance from nearest wellpµ_�1-Distance from foundation____ ° r .�__Q_ _____-Distance to nearest lot !in„_.�__----- a Number of lines----- _'_ __Length of each line-----C/_D-_'j, �OP.Widfh of trench___., Type of filter materia Depth of filter material____.--_I_._ - _ _._Total t x l _. length_______ DSeePage'Pif: istanc� to nearest well-14QKja___---Distance rom foundation__-�_ Distanfe to neare_st__l_ot_ l_i_ne -------- - material-4\0 Size: Diameter_ _r__ _Number of pits---- _ k-----. p __ _---'--_ th t J Cesspool: �,. Distance from neap f,kvell ., a-_-,Distanee'from-foundation:- _:�.._-__-r Lining material._.=__-_..�:--_m.____._ yj ---------- --- -------- Size: Diameter t - Depth ` .-=--=-"- -------------•------.-- Liquid Capacity------- --------------j--gals.6, I Privy: m - Distancl� from nearest well_�f.__.,r+--------------__--___ ~___ _ '. Distak?ce.'from nearest-b Adin ______ ______ -� ❑ Distance to nearest' dot line ._ w l Remodeling and/or repairing (describe) ________________ _ _. 1 "` --------------------------- ---------- --------------------------- ----•----------------- ------- I i --------. t - -� I I S __---------------------"='---.-- �M - ------ ------- ------------------------------------------------- i - 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=Joaquinslocal Health`District. Si ned -- t e €--------------------- Contractor) By:------ ------------------- --------------- ------------------------------------- (Title}:�------ -�--- ----------- - ---------_ -------- ---- -. ( (Piot plan, showing size of lot, location of system in relation wells, buildings, et , can be placed on reverse side). ' .. FOR DEPARTMENT USE;ONLY y' APPLICATION ACCEPTED �BY-----.------ 1--_G%�c�- ------- DATE--------2 � -- - ----------------------- ( REVIEWED BY------------ -- - --------------- ------ ------------- - -•----- ---------- •--------------------------------------- DATE------------ --------------- --------------- ------------- BUILDING PERMIT ISSUED-l�- ----r- --- DATE---------------- �- - Alterations and/or.recom eridations:___.__..____ _._ :___--------- -------------------J__-._- _flit ----_ ��,.�— `= --- --- ------ i �l z-. ------------------------- -- -------------------------------------- — — -----------------•--------------------•-------------------------- --------- �. _ J --------------------------- ----------- - -- ---------------- - FINAL INSPECTION BY:...�.�_� - r, Date 1� `s -- ------------ -------------------- 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.0 O.