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FOR OFFICE USE: - U�ya .> .�"�....._. APPLICATION FOR SANITATION PERMIT Permit No. --------- ---•--......:4 .- ....... (Complete in Duplicate) Expires "" This Permit ] Year From Date Issued . . Date issued _ •---=-r.__•---_-- 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 Ordinan No. 549. JOB ADDRESS AND LOCATION..2.7/1_- pC --•• .................. •-• --•••..............•---•-............... Owner's Nam !t?AQp'--e? J ----_--- _... ------------- -------- Phone...... Address__.__..: 7a.� -.._ Contractor's Name_._° ......................................................... ......_.._.........S.�S•.._-.,•.•-----•--•.._.. .._._............-.........................----- ------- .---•-------- Phone................................... Installation will servo: Residence ['Apartment House ❑ Commercial [Irt Trailer Cou Q Motel Q Other ❑ Number of living units: -7Number of bedrooms 2___ Number of baths A._ Lot size .l�O OC_30 a Water Supply: Public system ❑ Community system ❑ Private [All6epth to Water Table .4a ft. Character of soil to a-.depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9--`Hardpan ❑ Previous Application Made: (If yes,date... . ............. J No New Construct ion:' Yes [ No [IFHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0„ If Septic Tank: Distance from nearest well_4_p__.__-..Distance from foundation20. ..........Material_ No. of compartments.:.Z......... ........Size-----3__o 477 _-- _Liquid depth.__.. ut '�! �e} r ' _...•.r:4..._.---Capacity.. ,f..� Disposal Field: Distance from nearest well.�0_ ._....Distari e rorli t rh4dation-.�O_..._......_.Distance to nearest lot line r -.. I Number of lines......9 ........................Length of each line__745.- . of trench....rZ.11_'..._..._.•.......... Type of filter n-material�Q4_k_._.-_._De_Depth of filter material.../.$_" .........Total length....j�' p - ate . Seepage Pit: Distance to nearest well.J..b.Ar_.. 1 ...Distance rom foundation_40,!f to nearest lot line-5_--_--_..- �__--.Size: Diameter.._..3- ._..._.Depth._•ZcJ_.-.. Q� Number of prts.._,.'.L.-..--..•.-_.Lining maters__.�.!?.L.. .....••--.•..... Cesspool: Distance from nearest well............ Distance from foundation....................Lining material.._-..._............--____-..- ❑ .m Size: Diaeter----------------------_ -.._..Depth..........................-•• -------------_---.-.Liquid Capacity --gals. Privy: Distance from nearest well_...--------- -- _-__-----.--..-------.-Distance from nearest building .................... ........ ❑ Distance to nearest lot line........................._._.•-_...-_ I ........................................... Remodeling and/or repairing (describe)------- ----------- ._- •--•----•-----------------------------•"--.......-----•-•-••----..._.....-- ..............•-•---•--__......_...---........__--------......_...._......-------....._.. •--"----•--.._....._....._............................. ....•---- ► I hereby certify that I ave prepared this application and that the work will be done in accordance with San Joaquin County it ordinances, State laws, a rules and regu i sof the San Joaquin Local Health District, �r (Signed)... •- .- _-...----"-.._............ ..•........... -•-------------------------------- and/or Contractor) By:..............•..........--•-•----•-••---•------------_--------_--------------- ----------------•--------------- ----- Title ....................... i (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......... '-------- Com'--�-� ----- --• --------- DATE. ,/l_...,1...---------• -• RE-VIEWED BY....................................................•--...._.-. ------ ••---- .-..... DATE....•.•. ....................................................... BUt�DING PERMIT ISSUED................... ..................................•--- ..._...._..... - ;Alterations and or recommen ations. _____.._.... ...c._...1...t_..... — ----------------- PATE _ e � •••-- e,- ------ f'r d ......-_...�c�'?'�_t-t:a-c:--�`�.-�. c� a ................................ ------------------ ---- ................................... . FINAL INSPECTION BY:......... .... ... . � .. ��..ti�— -•----------• Date.............................• AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 0 West Oak Street it, 124 Sycamore Street 405 West 9th Street Stockton,California zti, Lodi,California Manteca,California Tracy,California