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FOR OFFICE USE: _ Permit No. _----------------- ---- --------- APPLICATION FOR SANITATION PERMIT ------- --- --- ------ "-- - ---------- ---- (Complete in Duplicate) Date Issued ------- ----- ---- ----- -------------- -------- ---- ----------------------------------- =i::#lis-Permit Ex ices 1 Year From Date issued • hereby made to the San Joaquin Local Health District o a permit to construct an Application is hd -Install the work herein describe y This application is made in compliancewith County Ordinance C I S _a_ -4w�_n� ---------- Y--•----- JOB ADDRESS AND LOCATION------------- Phone-------------- Owner's Name---------------------1 ------- -----•--- "' --•_---------------------------------------- ' Address-------------------•-----------•----•-----•------ r Phone.. --•-- Contractor's Name--------------------------------------------------------- ------- - ------------------------••----•-------- Motel ❑ Other ❑ artment House ❑ Commercial ❑. Trailer Court ❑ n Installation will serve: Residence Ap 1r ��__A-•--•-------------------- __ ___ Number of baths _-_1 -- Lot size __-_____ __-- Number of living units: __.�__ Number of bedrooms _ }h to Water Table 0(2 ft. _ Water Supply: Public system ❑ Community system ❑ Private [?""Depth _ _ adobe ardpan ❑ pPY� �Clay Loam❑ CIaY 1] P Gravel ❑ Sandy Loam FHA/VA: Yes ❑ No ❑' Cliaracter�of soil to a de th of 3 feet: Sand ❑ 2o —New Construction: Yes ❑ No Previous Application Made: (if yes,date---------- : } No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within ion feet.) Material_-.-___------------------------------- --- --- Septic Tank: Tl istance from nearest well-----------------Distance from foundat'son__-_._._____-..._. No. of tom artmen#s Size------ --------------------Liquid depth Capacity ' p . Vv j .__-":Distance from foundation__---_v- --Distance to nearest lot line--__ Disposal Field: Distance from nearest we Length of each line-_____... Width of trench."__-.c6?---.- C _____________________ A1. Number of 4ines ----------- - 9 Total length___._a�-�a� 1 Type of filter material-�g'�=- ----Depth of filter matenal___�-�--� ----- t a e Pit: Distance to near est well----------------------Distaa4 e from founds Tion Diameter..............Distance to Deaprest lot ine_-._"._.__-___-•- Seep g ❑ Number of pits --------- Lin ng mate + gals. i ining material— Distance from nearest well_________________Distance from foundation_.------ Liquid Capac ty_ Cesspool: - Depth_- Size: Diameter. •. -------- ---- " -. :- Distance from nearest building-- �J Distance from nearest we4------ ---------------------------------- ----------------- Privy: ❑ Dis#ante to nearest lot line---------------- I Remodeling and/or repairing (describe)----------------------------------- _"_ --------------------- ------------------------------------------------------ ---------------- ------------------•---•--------------------------------- -------------------------------------------------- ----------------------------------- I hereby certify th t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws and rules and regulations a San Joaquin Lacal Health District. ----(Owner and/or Contractor) (Signed)------ -- -- --- - - Title Y - ----------------------------------- ------------------- -- -- - ----- ati.--- �� (Plot plan, showing size of lot, location of system in relation°ta wells, buildings, etc., can be placed on reverse side). l F It D PARTMENT USE ONLY ----- ---------------------------- DATE-------- �- � {---------------------- ---.._ DAT -------- ------------------------------------------------ -- --------------------- -------- ---------- ----- APPLICATION ACCEPT i - -- -- ------ DATE-------------------------- REVIEWED BY - BUILDING PERMIT I UED- ----=---------- ------------------------- ------------•--" -------------------- Alterations and/or recommendations:--._---"-- ---- -_-----___.-------------------------------------- ------------- -------------------------- -- --------------------------------------------------- ----- --------------- - --------------- ---------------------------------- ----- --- -------- --------- ---------- . - - FINAL INSPECTION BY:----------- ------- SAN JOAQUIN LOCAL HEALTH IS CT 203 west 9th Street �( i 124 Sycamore Street 300 West Oak Street Tracy,California 1401 E.Mnielton Ave. - Manteca,California - I Lodi,California. Stockton,canfornia r • F.P.CO. '�