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rutsvrrl�t uat; ----------------- ------------------ -----------.------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. ------------ - -------------------- --------------------- (Complete in Duplicate) ------- This Permit Expires l Year From Date Issued 06 D to Issued 16 oz---------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the rk hrdrein de ribed. This application is made in compliance with County Ordinance No. 549. 1. ego % I F•+�4- kc—`( f__J / f J B kADDRESS AND LOCATION- �S`t f/ r'�d_ d../ _ �11_� ..- _1� - =-•----•----•-- Owner's Name---------- �_ e1 ��: _'e--•-----Shl.f1�'-- --C�-- ---------------•- ----------------- --- ----------------------- -------- -- Phone---------------- Address R �'` 016?-r-, '. ----------- -----------------------_ --------- ------ Contractor's Name-------------...4pl ---7=�eaI5,7e-------------------------•----------- - --------------- Phone---- ---••------------••----------- - ------------------- Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms 3___ Number of baths _e2___ Lot size 40� _ e_�OAO_e Water Supply: Public system ❑ Community system ❑ Private 99"'bepfh to Water Table Gil/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Er"Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: (If yes,dote..-------- --------.) No gj-' New Construction: Yes �No El FHA/VA: Yes �' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearesf well__�AP__.-Distance from fou dation-__ ._-_.'.Material__ ._ _ < ------ s - i No. of compartments-.-_ _________________Size _.___...___CapacityZ.ZA Disposal Field: Distance from nearest well-_--Si1!rQDistance from foundation---e�o /.._.Distance to nearest lot line-________ � Number of fines....___------ Length of each hne��V_--____`--__-.Width of trench--�_-------- - ----- �e'! . Type of filter material:/�fe�r. Depth of filter mater3aL.__f�_ _,.Total length.. '---.---___-�-_--_ + �.F" __.Disfa fie to nearest lot line...�..._ , Seepage Pit: Distance to nearest well--2- - Distance from foundation___ Number of pits-7--14 __ _Linin materiaf_____+ jP0°;:Size: Diameter.. k—o� �- 1" Cesspool: Distance from nearest wefi-----------------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______________________ _ Remodeling and/or repairing (describe)------------------- . i. W'.-------------------- ------------------------------ --------------------------------------------------------- ---------------------------------------------- -------- -------------------------------------------------------------- - -------- t . FC 000 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)----------------------------- 1 -- --------------------------------------- r Contractor] � - By---------------------------------------------------------------------- - (Title( .(Plot plan, showing size of lot;-location°of system i r ation to wells, buildings;etc.,cerf"be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- J w �� DATE' t ---- --------------------------------- REVIEWED BY------------- --- --------------------- --�------------------------- - ---------------------- ------------------- DATE ------------- ----------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------_DATE----------------------------- - -- -- --------------- A terations and/or recommendations------------------ -------------------------- - ----------------------------------------- -- -------------------------- --------•----------- ----------------------------------------------------------------- ---------------------------------------------------------•----------•----------- --------------- --------•------ - ....... -•-------------------------------------------- ----------------------------------------------------------- ---------------------------------- FINAL INSPECTION BY: �1 •_ .."r!C Date J 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.co.