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FUROFFICE USE: ;- r_-_--- ..----_--�� --- -��-_ APPLICATION FOR, -SANITATION PERMIT Permit No. ;Zzre -._-• ---------------- ----------------- -------------- (Complete in Duplicate) ----------- This Permit Expires 1 Year From Date Issued Date Issued -----`-----_- Application is hereby made to the San Joaquin Local Health District for a permit to onstruc arpd i all th wor er 'n Gs�cri ed. This application is made in compliance with County Ordinance No. 549. f 'Re JOB ADDRESS ANFLOATIO -7� ___ .- ----- --- - -- --- --------------- Owner's Name --- ------ Phone. l �. Address....--------_----- 7 ... .----- -- -- - ---- Contractor's Name. .._ - � ----- --- Phone--�----------- Installation will serve: Residence partment ❑ om ercial ❑ Trailer ourt ❑ Mgtel ❑ Other ❑ Number of living units: Number of bedrooms ..- _.- Number of baths Of size ----- ---- Wafer - _Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .1LiO ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ee Hardpan ❑ Previous Application Made: (If yea,date------------.. .....J No ❑ New Construction: Yes ❑ No "HAMA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ~ I ti Distance from nearest welL._.-------- ---Distance from foundation------------ ----,Materia!_....._.__-..-____.-..-._....---....-__...-.---. No. of compartments-- -----------------------Size---------- ---------------------Liquid dep�------------------------Capacity----------------------- o 11d• Distance from nearest well.1__Q.0_--..Distance from foundation - .Distance to nearest lot line--".T- Numbert� of lines... _____. Len th of each line -- �' •g �- ----- 9 �4_ da Width n trench--- C- --- --Type of filter material -Depth of filter materia __--- - 01 Total length-----------------...... Seepage Pit: Distance to nearest well---w-1,04 .......Distant—from foundation--- ..Distance to nearest lot Number of pits---.-------- -----Lining material., atSize: Diameter_-.:.- it De th.Z 0' Cesspool: Distance from nearest well.................Distance fro foundation---_--.---..-___....Lining ma#erial-___-....-.--.--_._......_ ' ' ❑ Size: Diameter-t---- ------ -------- ------ ----Depth-------------------------------- ---------------Liquid Capacity-.--------------------------gals. Priv t y: Distance from nearest well------------------------------------------------- from nearest building_-_-_...._----....-__.-..-. _ -_. ❑ Distance to nearest lot line-_-------------------------- --------- - -- ------ --------------------- I I Remodeling and/or repairing (clesc�ibe�-_.-,..-^-- ___- _... - �!4. - . P -- ----- - 1 i.J� __ip _ -------- ----------------------- --- --------IZZ -- - ---------- ---------------------------••----- ----------------• - - -- --------I-------------------- ------ -------------------------------------------------- k ............................................................. -------------------------------------------------------------------------------------------------------------------------------------------I-------------------- kt I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules acid regulations of the San Joaquin Local Health District, 47 I (Signed} iC -- - -�-"� �----------- ---- - �---- -- � r r Contractor) By----------------------------------------------- --------------------------------------------- ; ---(Title)----------------------------- (Plot plan, showing size of lot, location of system in relation to wel buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY �7 APPLICATION ACCEPTED ----------- -1d------------ ------------ -- DATE------ REVIEWED BY. - ----------- ---- DATE--------------------•--- - --- - -- ----- ----------------------- BUILDING PERMIT 1SSUED--------------------------------------- -------------- ------- DATE Alterations and/or recommendations:----------------------_ ------- --------------------------------------------------------------- -------------- ---------- - -------------------------- ------------------------------- _ FINAL INSPECTIONBYr_- ' ., --------- ----- - Date---- ---�_`-1..-._ .._....� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, k 300 West Oak Street 124 Sycamore Sheer 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.0 O. � r r I