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FOR OFFICE USE: II , APPLICATION FOR SANITATION PERMIT Permit No. -�� •. ----11 (Complete in Duplicate) Date Issued _ 3------- . i1 This PerEx ires 1 Year From Date Issued - Application is hereby made�t This application is mada.in.compliance with the San Joaquin Local Health District for a permit to construct and install the work herein descrl ith County Ordinance No. 549. ZD �� en7G JOB ADDRESS AND LOCATION._ rrtnc$_ .'_fQ_.cCny __ _._L - I:s __l�01,,�_ _. _ •-------•------ Owners Name--------------IllC Y' x' - -------------------------- - Phone--•- -- ----------- il. Address--------------------------/ - Y--------•---------•------------------------------------- ----------------- - �Contractor's Name--------------0- -------------------------------------------------- Phone �M Installation will serve: Residence Apartment House [ICommercial E] Trailer Cour} ❑ Motel ❑ Other [I :----------------------------- Number of living units: ---I--- Number of bedrooms __A__ Number of baths -1..._ Lot size --------- FWater Supply: Public syst�i'm ❑ Community system ❑ Private [Depth to Water Table 20.- ft. Character of soil to a depth 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam E]' Clay E] Adobe C] Hard ❑ Previous Application Madel (If yes,date-- .__-------) No [a/New Construction: Yes El No ElFHA/VA: Yes E] No �— I TYPE OF INSTALLATIONIlAND SPECIFICATIONS: :.. (No septic tank or cesspool permtted if public sewer.is available within 200 feet.) G r Septic Tank: Distance from nearest well-'.1q,-------Distance from foundation_.___/3_.______.Mataria4___- . 1 3• Capacity----------------------- [P11, ----�- ---------- - LPNo. of1compartments-.-.-- r I-----Size/�X�!----'qj----'------Liquid depth-----1A ------ Disposal Field: Distance from nearest well___rU-- .--Distance from foundation__ _ $_________.Distance to nearest lot line---- Number of lines------ --- ---------------------Length of each line------------ -U----------Width of trench_..._r` - --------------------- C sf :, �' ------ Total length--------P-1-U----------------------- Type of filter matenal_6�__l�+ t--___--'__De th of�filter material-. c�-__.___- p r Seepage Pit: Distance to nearest well_____________._.___r Distance-from ifoundation=----------------Distance,to nearest lot line_____.-__...._.__ Number of pits '-------------Lining material,_~ = ------,.Size: Diameter- --------- ------=--Deptin------------------------------- ❑ jf. Cesspool: DistanFe from nearest wel ----------------- from-foundation............... ....Lining material----------------------- -------------- - als. Size:: �iameter------ ' ------------- Depth ------------------------- =_'Liquid Capacity_. 9 ❑ t ' Distance from nearest building----------------------------- ----------- k: a_ Privy: Distance from nearest well--------------------------- -------------- ❑ F -----------------•------------------- Distbnce to nearest lot line--------------------------------------------------- -----------------------------• ------- •----------- Remodeing and/or repa - g (describe)---- ----------------------------- :_I---------------------- --------------------------'---------------------------------------- ---------- ------------------------------------ I' -------------------------------------------------------------------------------------------- -- --- ----- I hereby certify thati�l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguia 'ons of the San Joaquin Local Health District. I (Owner and/or Contractor) (Signed)-------- ------ ---------------- ---- -------------------------------------' ------------ -------- By:------• •------------------ ----------------------------------------------- ------- (Title) :-------------------- ------------ -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). � 11 �! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- DATE----- -'_ -�6------------------------------ DATE----------------------------- - - ' -- - - -- ---------------- REVIEWED BY--------------------- --- TE BUILDING PERMIT ISSUED- -------------------------------- ----------------------------------------- ---------- -- ------- DA ---------------- -------- Alterations and/or recommendations----------- ----------------------- ------------ ---------- -------------------------------------------------------- -- ------------------------- iIM --------------•-------•--------------------------------------------------- IM: ------ ------------------------------------------------ � ----------------------------------------------------- FINAL INSPECTION BY:_ _.- ------------------- P61 -------- -'�-— --------- ------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3o0 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,Californiah _