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/FOROFFIC r.- n_ -.- .�i - --..- APPLICATION FOR�SANITATION PERMIT hermit No. (Complete in Dupl catej 1 _ -"Date Issued -`------------------- --- ------------ This Permit Ex fres 1 Year Frorn 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. 549. �7 C' JOB ADDRESS AND LOCATION ----- ---•----•-••------------------------- ---------------------------------------------- -- - Y Owner's Name-..--------- + Phone..� .. G-� 7- ---- ------------- Address_ - .: ,5� Contractor`s Name ---------------------------------------- ----------•-- Phone.---------------------------------- Installation --- •--=-•------------------•- Installation will serve: Residence Apartment House ❑ Commercial ,[]. Trailer Court�❑_Motelx,❑_Other L] ! Number of living units: _-_./--- Number of bedrooms --- Number of baths __/- Lot size - _ _r---- -------------- Water Supply: Public system �ommunity system E] Private E] Depth to Water Table _�� ft. I Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Applicatio-�.�.,,.,.. - ,n°.Made: (if Vi — yes,dote___________________} No EI New Construction: Yes �No ❑ FHA/VA: Yes El No __ TYPE F INSTALLATION AND SPECIFICATIONS: -(No septic tank or cesspool'permitted if public sewer is available within 200 feet.) Se•Ptic Tank: Distance from nearest well-- -__D` -- _-Distance from foundation------4a------.. ----- Liquid Materials `` .� . No. of compartments-------------- -=-----Size-__- '.,Sw - -.-:---Llquld depth------- :'S----------,.Capacity---- Disposal Field: Distance from nearest well-._.�k...Distance from foundation.----A9--_--r-.-Distance to nearest lot line__ -_--.-- Number of lines------ ------- ---_- Length of each line------- - S`4 __ - ,�,� 9 __- ..�.� '�--T---�,• ---.Width of trench------ --=��-- - -------- I T e of filt&,materi _ /c-__GC__De th offilter material__--___1s�__ . Yp � P =-----Total length--= d----------------------- J Seep? It: Dis#ante to nearest well----- foundation---_ l i y P '� �(}---_----.Distance to nearest lot line---J ------.-_ i;_ m Number of pits_----.__�'1--.._-._-_Lining material.--Rtg�/�......Size: Der._. -4/d_�____Depth.......1l�_-�__.____________, p Size: Diameter-------- '" (Depth ` I i Cess ool: Distance-from nearest,well-------__!!!'!rDistance from foundation-_---_----_.______.Lining material----------------------_-------.-- - �.t f f❑ Depth =` --- ------- ---------Liquid Capacity-------------------- gals. 6 Privy: Distance.-from nearest.well--_--__.^--- - --- -----------------------------------Distance from nearest buildng.- i -.-.__------_--_--_________ --- --- S' Distanceto nearest lot line -------------"-------------- ----------- --•---------------,..------------------------ ------------------------- ----------------- Remodeling and/or repa=iring)`describe):-----_- --------------------------- ----------•-----------------------------•--------- ----•------------ ------------(---=--•.=--- -------•---•------------_-----------------------------------_-------------------=-----•------------------------------------------------------------------ ---------- r , - -=-------------------- •--------------------------------=----------------------------------------------------------------------------------------------------------- I hereby certify that I hatve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sate laws, an rules an egulationso the San Joaquin Local Health District. (signed)_ : sp, = ---------------------------.-.(Owner and/or Contractor) By: - _ - (Title) ----------- - - ------------------ (Plot plan, showing size of lot;location-of system in relation to wells, buildings, etc., can be placed on reverse side). [ 3 : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------- ------------ DATE.---- = �� REVIEWED BY - - - DATE--------------------------- " -• BUILDING PERMIT ISSUED---I-------NS- --__�=__ --f ! - �_V_ —-- DAT Alterations and/or recommendations'--........-- -------------- E ---------------- ,�,.X , ,r_ -..yam --r-�----------- --:--- - - •---------•--------------------------'- _ _ =-------------------------- -• --- •------ � -------- ---------- �•� �..r%� w X. FINAL INSPECTION BY:... - r JA ' 1 Date------- ----- 1f � SANiJOAQUIN LOCAL HEALTH DISTRICT 1601 E.hla:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi,-,California Manteca,California Tracy,California IS--%9 3M 3-163 F.p.CC. - a