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FOR OFFICE USE: ---------------- Permit No. APPLICATION FOR SANITATION PERMIT --------------- -------------- ----------- --- --- -- (Complete in Duplicate) Date Issued 7-=ll-= 7 - ---------------- -------------------- _ _ - ------ --- This Permit Expires 1 Year From Date IssuedPut Application is hereby made to the San Joaquin Local Health District for a permit to cons Tistall the work herein described. This application is made in compliance with County Ordinance No. 549. S [ZX - ---- --- JOB ADDRESS A?, LOCATION-- ----------------------------- - Phone----------------------------------- Owner's Name ---•--- ----- -- --, - ---- -------- -•--- -••----------------------•"--------•---------•-------------------------•- Address------- - �---- - - Phone • Contractor's Name---- 1 - ------ ----- Commercial ❑ Trailer Court ❑ Motel [:] Othe t House Installation will serve: Residence ❑� Apartment F1 - Number of living units: "�`"_ Number of bedrooms a�- Number baths __ --- Lot size _ c system Community system ❑ Private [Depth to Water Table . __._ ft. i Water Supply: Publi y ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 171 Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date_..- l No ❑ New Construction: Yes ❑ No ElFHA/VA: Yes ❑ No El 3 a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)t )IS - ---- ------ Septic Distance from nearest well--_�a_------Distance from foundation----/.p---------Materi l---- Capacity Size �� _ -----Liquid depth-------�' --------- P Y--- �+J No. of compartments...---�---------'- / lot -�... op i Dispos ie4d: Distance from nearest well -.-Distance from foundation.--fO---- Width ofttrench�st line__--_:--. : O ' Number of lines#--------I-----------------------Length of each line---.---- -----A� Type of filter material------- --dam_ ---Depth of filter material-------1-q--.------Total length__.-y_li--•------------- Seepa Pit: Distance to newest well_.__ _dQ- -----Distance from oundation_-__/Q- -------Dace to nearest lot i_ .. -.Size: Diameter._u?. __------ p Lining th.. Number of pits..-----�- ---- --- 9 material------ - . ing mc Cesspool: Distance from earest well.................Distance from foundation___.------ Liquid Capacity gals. ' ❑ Size: Diameter_] ----Depth---------------------------------------------------- Privy: -------------------- ---------------------------- 9 P Y Privy: Distance from r;earest well----------------------------------------------- --Distance from nearest building-------------------------------------- 4 ❑ Distance to nearest lot ine----------------------------- --------"-�-----'- ----------------------- k f 1 Remodeling and/or repairing (describe):---- - --------------------- ------ _--•-------------------•-__----..-__-------___----.--------------------------- . _______________ _-._._.___..-------- ----_---------- _____"___._______-_ i.t - ------------------"----------------. ------------------------------------------------------------------------------------_- "_____. _______.._______ . ------ ---------------------------------------------------____---------------------_------_----------------- ___.__________ __will be done in accordance with San Joaquin County _-___---"--.-____---_.-__-".-_--____.---.___--_----_-_--_------__-._-. .. i I hereby certify that l have prepared this application and that the work ations of the San Joaquin Local Health District. ordinances, State laws, and rules and regul ' ------- -ct@wmr and/or Contract or) (Signed)------------------- '---------- (Title)- ----------- ------ ----------- -------- ------ BY: - -- - ---- --- ------------------ ----- ---- ------- f------- --- . (Plot plan, showing size of lot, location of system in relation t welds, buildings, eft., can be placed on reverse side. FOR DEPARTMENT USE ONLY � ------- ------------------------------- ----- DATE---.�----� ------- --- ------ ---- APPLICATION ACCEPTED BY - -- -- --- - - -- REVIEWED BY------------------ -------------------- - - ----- -------- = DATE } BUILDING PERMIT ISSUED ----------I--------- -------- - - -------------------- --------- Alterations and/or recommen ations:_..__---------------------------------- ---------•----------- --------- I ----------- ------------- ------------------------------------"--- f - - -- ! Dafie._ /.._.`_. -•--------------------------------------- FINAL INSPECTION BY ..... -- ---- -- -- . SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th Street 1601 E.Haielton Ave. 3oo West Oak Street 124 Sycamore Street Lodi,California Manteca,California Tracy,California Stockton,California