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a FOR OFFICE USE: -- --- ---- -- --------------------------- ------------ -- APPLICATION FOR SANITATION PERMIT Permit No. ----- --------- -------- ------- -- ---------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued "-err pfd n Joaquin Local Health District for a permit to construct and install the work rein described Application is herebymade to the Sa This application is made in c}o liance with Count%r Ordinance No. 549. 1/V r� e fir'-------�1_RP©�T�-------�� JOB ADDRESSAND Loyr --��--- - - =--------- C7------. -- --------- 74G1-V R. . .... Phone-----•------------------------------ Owners Name_________ _____________ - Address C-1---- OX-------1-8 7-------�-•-�•--------- - ~ 1 Phone---------------------------------- Coptractor's'Name-= ---•- �� -----------------13 f artment.House ❑r,Commer�al"railer-Court ❑ Motel ❑ Other ❑ Installation will serve: Residence ❑ Ap ', Number of living units: -------- Number of`-bedrooms•� �'ber of baths -------- Lot size __ _ _ A_GF— Water Supply: Public system ❑ Community system,❑ Private 0__`6epth to Water Table ft. .._ Character of soil tb a dep.th of 3.#eet:. San -Cr el ❑', Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date______..__. _.l No New Construction: Yes o ❑ FHA/VA: Yes E] No E TYPE OF INSTALLATION AND SPECIFICATIONS: _00 y �� {No septic tank or cess col ermitted if ublic sewer Is avatlabie within 200 feet. P P P Septic Tank: Distance'irom nearest well__.J�0_____ -Distance from foundation_____ __ Materi I_�® �1- ---------- Capacity--- No. -------_-- (v No. of compartments..............__._---. Size__ ! �Q__X -Liquid.clepth �- Capacity Disposal Field: Distance from nearest well 5_0...Distance from foundation___I��_1-.Distance to nearest lot line_�_�_____ Number of lines----------f.____________________Length of each line__._-_.-� p---�y Width of french--------- ------- --------- El Type of filter material---R0Cl<----Depth of filter material.- ----------Total length-----J49 ------------ -------- Seepage Pit: Distance to nearest well_-------------------Distance from foundation------------------- Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---------- ----------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____________ ___..Lining material_.______...__..___.---.____---__._- ❑ Size: Diameter----------------------------- ----- P ----De th----------------------------------- ---------=----Liquid Capacity----------------------------ga . - Privy: Distance from nearest well------------------------------ ...__Distance from nearest building.----------------------------------------- ❑ Distance to nearest lot line------ ----------------------- --------------------------------------- ----------------------------------------------- <.. M - ------S, ;P-------------------------------------------------- Remodeling and/or repairing (describe):_____. . .._ --------------------------------------------- --------------------------------------------------------- ----- ---- -----------------------------------------•---------------------------------------:-------------------------------------- --------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelas, rules nd regulations of the San Joaquin Local Health District. _----------_----------------- -{Owner and/or Contractor) (Signed)----� - �� -/ - - --- --- - --- ----- ---- -- -------- -1 ---- -- ------,•- _ �t - --------------------------------------- {Tit e) •- - -- ----- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- I `R Q----- - --------------- ------ DATE------Imo__~I --------------------------- ----- REVIEWED BY---- ------------------ --- -------------- ----- ----- ------------ ----------- ----- ------------------ --------- DATE------------------------------------------------------- ---- BUILDING PERMIT ISSUTAD------------------------------------------------------------------- ---------------------------------- DATE----------------------- --------------------------------- Alterations and/or recommendations:__.-....__.__ ------------------------------------------------------------------------------•------- -- --------- ------------ -------- ---- ------ � / � & - ------------------------------ I ? - --FINAL WSp4 Date--.SANJOAQUIN LOCAL HEALTH DISTRICT 1601 E.maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.