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FOR 01 1`ICE USE: APPLICATION FOR SANITATION PERMIT Permit No. I -_-�------- (Complete in Duplicate) /0 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. No. 549. JOB ADDRESS ANDi�LOCATION--.-52� -5'n ---,E f7RT'D.M_ ------------------------------------------------------------------------------ _ Name _�1 _ r.. ..... 7--------.`..-------••-------------------•-•------- -------------------------------------- Phone Address---------J.a57t--•--- �N W." -------------------- IPhone....................... ---------- Installation Name---��_��!��_..�_..--�-•--------------------------------------------••-------------------------------••-------••-•---- Installation will serve: SResidence ❑ Appart ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherDR Number of livin unit_- Number of bedrooms ________ Number of baths -------- Lot size _______________________________________________�lli_ �-t—� g Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table 7-::F_ ft. 'f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------------_Distance from foundation-------------------.Material ______________.________---._________.__________- ❑ No. of compartments------ -------------------Size-----••---------------------:...Liquid depth--------------------------Capacity------------- ------ Disposal Field: Distance from nearest well_________________Distance from foundation____.-._-________...Distance to nearest lot line------------ 0 Number of lines-----------------------------------Length of each line------------------------------Width of french.-------------- ------ Type of filter material-------------------------Depth of filter material____________________._Total length----------..._______. _.--_________....--.- {1 Seepage Pit: Distance to nearest well_ION_1,E-Disfante from foundation--/D____..___.DVae to nearest lot line____ Number of pits______ _.________Lining material__pfv_��.--Size: Diameter___ --____Depth__.__--_ Cesspool: Distance from nearest well________________ Distance from foundation_-.---------------.L/lining material-___________..______________________ rn ❑ Size: Diameter--------------------------------------Depth----------------------------------------•-----------Liquid Capacity---------------------- -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line--------------------------------------------------------------_-------------•------------------•-------------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------- ---------------------------- -------------------------------------- -------------------------•---•---------•------------------------------------------•----------------------------...----------------------------------------•----•-------------------- - ----------------------------------•-------------------------------------------------•------•---------•--•--------------------------•--•---------------------------- -----------------------------------------------•------------------•------------------•-------------------------------------------••-----------------•------••----------------------------•----------------------------------- I hereby certify that I have prepared this application and that Ae work will be done in accordance with San Joaquin Counfyd ordinances, S laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- - •-`--`-' - ---------------- --------------------------- --------------------------------------------------------- ------{Owner and/or Contractor) �"---------=Z� By:._.. --------------------------•--------------------------•---------.---------------------------------(Title)----------------------------- -------- ----- -- -------------- (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _77APPLICATION ACCEPTED BY--------- R,--O-'----------------------------------------- DATE � x( REVIEWEDBY-------------------------------------------------------------- ---- ------------------------•------- DATE-----------•----------------------------------------------- BUILDING PERMIT ISSUED------------------------ �- ° --_ .. DATE --- -- Alterations and/or recommendations` `/ A --------------------------------------------------------- ---- -- --- - ----------- - - -- --[d` _"'-_ __ ---------------� ---'. -----------------•------------------- ��.--•----- -------�- -- -------•-•— -- --- - -_ -------------------- -------------- ------ -•-- • --`�"--�+�-------------- fi.�-mac.,.__. �--�-----G-�►�..�------- -----•• - - - �-----�------ ; -- --------------------------•---------------.------------------------------------:-- ----------------------------------- FINALINSPECTION BY:--------------------------------------------- ---------- ------ Date ---------------------------- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,Collfornla Lodi,California Manteca,California Tracy,California E6.9 REV16E0 e.e9 r.P,P0.2M 6.60