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f I L �^ -Ski ............. APPLICATION FOR SANITATION PERMIT Permit No. . ._ (Complete in Duplicate) is Permit Expires 1 Year From Date Issued - - _ Dote Issued Th 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 C unty r finance No. 549. /050 JOB ADDRESS AND LOCATI N...dva,-A, Owner's Name.. - Phone--- ------------ f. - ----- - --- -. -- Address-----_--- Contractor's Name_...._. .._._ ... ....___j.... -_ . ._.-.- - .. ..... - Phone. - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Number of living units: Number of bedrooms _...-r Number of baths .a. Lot size : - --. ---- -- .11 Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cfoy ❑ Adobe 2-"Hardpan ❑ Previous Application Made: (If yes,date ) No New Construction: Yes U?"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-AV..W- Distance J-rom f ndation._l -. M No. of compartments_' �..--.--Sizey .__-._ .•..-_-Liquid depth .- 2` Capacity Disposal d: Distance from nearest well/".. Distance from n atio ,„ 9-,,�� . . ...yDistance to nearest lot line._��-�_ � Number of lines... .._ �. _ Length of eacFi Ii ti;9 / �-Width of trench 92.,..... _ v Type of filter mate rial1,,4r�616 Depth of filter material_ Vi'^ Total len th... `� r � C' Seepage Pit: Distance to nearest well - Q� .Distance fro fou dation -_./-.('> Distance to nearest lot line .- Number of pits .� Lining material._ ` Size: Diameter Depth %0 /�.' Cesspool: Distance from nearest well...... . . .....Distance from foundation Lining material. ❑ Size: Diameter .Depth__. _ . _ Liquid Capacity. _ _ gals. Privy: Distance from nearest well _ Distance from nearest building... Distance to nearest lot line Remodelingand/or repairing describe an / P 9 ( ) 4�l��Z/✓SIG/�� - - -��--�� - ' -- -------------- ---- C . ---- -------- - -- 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 Joaquin Local Health District. (Signed)._...... .......... �_ 4- �-V_ _ -- .. -- J -.._. .. Contractor) BY - - - v�1-. ---(Title)-- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..��.•_.- --- �t�� _tra�. _ ------------- --- -- --------- ------ DATE_. REVIEWED BY- .. DATE BUILDING PERMIT ISSUED._ _- �- --� _ DATE. r � - -- ... Alter ions and or recommendations:...�� ... . _...��. - l -G------- }�� --- --- ----- ._ _ - _ .... ..... .. �c�u�- ... .... .max------ . FINAL INSPECTION BY:._, c..,, c �- -. ..... ...._ Date.. S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 12j Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca.