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OR OFFICE USE: /1 s � �- ------------------------ ------ -- � APPLICATION FOR SANITATION PERMIT Permit No. . .............. ------------------ --- --------------------------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued S9 300--1 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. 544.g4,,.,,, JOB ADDRESS AND LOCATION r✓ -- -----401-0-------- ` a C. ------------------------------------------------- Owner's Name Name----R,------ppft&,_ --- ------------------------ --.---------------------------- --------------------------------------- Phone------------------------------------ Address- -------------------------------------------------------------------------------------------------•-----------------------------... Contractor's Name--- c �7� M1 ------------------ Phone------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:q------- Number of bedrooms _1_ Number of baths I---- Loti size ___.KZK�----------------------------_--_ Water Supply: Public system O—Community system ❑ Private ❑ Depth to Water Table ft. Character of soil 4U-5`depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M—Hardpan ❑ 44 Previous Applicafiori-Made: (If yes,date--------..- ..---1 No © New Construction: Yes ©�No ❑ PHA/VA: Yes ❑ No F}-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Ta k: Distance from nearest well -------Distance from foundation_1A......._..--.Material___ F"�' ? +- -..-__---_. . No. of compartments- � -------- 3 x X q p Capacity Size -----6-- ----- Li uid de th------f__ Ca acit �__ Dispos Field: Distance from nearest wel).--- `---------Distance from fcundationJ _..'_----------Distance to nearest lot Number of lines----/--------------------------__-Length of each line------94- .------------._.Widtil of trench.....F;?4,.___................ Type of filter material.-®_f 5--_----_-Depth of filter material-,/S------- ---------Total length--------9d-�----------___________ Seepage Pit: Distance to .nearest well----------------------Distance from foundation---fa___---_-__.Distance to nearest lot line_,•'.._------_._. 1I/ Number of pits----I----------------Lining rnaterial_'R2k� ------Size: Diameter._._.�.?_3------..__-Dept h_.----7-:—'__�_----- ...___- Cesspool: Distance from nearest well-----------------Distance from foundation-----_._ ......Lining material ..._-_-.-.---.-----.---------------- . �` Size: Diameter------------------ ........Deth---------------------------- ----.----------Liquid Capacity ---.-._-_-.gals. Privy: Distance from nearest well-----.----_---- - --------------------------Distance from nearest building_.-----.-.-------__-.--_-_.- � ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------=-------------------------------------------------- ------ Remodelingand/or repairing (describe-------- ---------------- '--------------------------------------------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - 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, an ,rules and regal ions of the San Joaquin Local Health District. (Signed)----------- + { -f { (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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- - ------------------------------- ---------------------------------------- DATE------f2'l llell 5, REVIEWEDBY--------------------------------------- ---------------------------------------- --------------------------------- --------- DATE------------ --------------- ---- --- BUILDINGPERMIT ISSUED--------------------------------- -------------------- ----------------------------------------------- DATE------------------------------------------------------------ Alteration ,end/or recommendatio s----------------------------------------- - - ------------------------------------ ------------------------------------------------ ------------------------- i ------------------------ -------e o _ .---- --------- - ---- -- ---------------- -------------------------- f- --------------�J--------------------- --------------------- --------- -----•-- • -------- ----------------------------------------------------------------------------------- ------------------------------._. --------- ----------- ------------------------------ I i FINAL INSPECTION BY: Da+ef ------------------------- ------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.RCC.