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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- tz��__-__-� -- --------------------------- --------- mDuplicate) --- --------- (Complete in - Date Issued ------------------_._---_-- ------------- __.______---. This Permit Expires 1 Year From 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. C0p 7 - f<�V-- 3a S. ____________________________ J08 ADORES LOCATION--�-------- �f'�.+J----�G�-�--�`--- -�------------"',�----- -��---------`_:_ _ Owner's Na •--------------------------- -. Phone = - I M s Address------ - -------F � ��-: �� r j --4r --------------------••- ----------------- - Contractor's Name------ 'LKs. 3a`'`� 'Ca Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms_.- Number baths _:k-7Lot size ---- -------------------- Water Supply: Public system E] Community system E] Private epth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic/Tank: Distance from nearest well__J'._;_*'___Distance from foundation______!_17___-__-_ Material----1 ____________________________________ No. of compartments_._-_.-"�<---------Size---Y_f�_��_f'AIA."Liquid depth-----(./_.�____---------Capacity__l_�_-c�6?__ � d c?'_____________ -- (/ 1 Disposal field: Distance from nearest well____-�____-._Distance from foundation:__G_4__r________-Distance to nearest lot line__ _ �. p ER Number of lines-----------/-----------------------Length of each line-J-91 of trench----�-�--- _-----.-- Q Type of filter material--------&-k-r------Depth of filter material__-__ _�-- ---------Total length___, _G'®_______________ Seepa e Pit: Distance to nearest well-----1.84_(--------Distance from foundation----ZV Distance to nearest lot [ Number of pits.-----� g - -----Dept Linin matenaL__-__.�.�-- Size: Diameter___ . Cesspool: Distance from nearest well-----------------Distance from foundation----------._*..._-Lining material------------------------------------ Fl ______________________________ _❑ Size: Diameter----- --------------- ----- - - - ----Depth----------------------------------------------------Liquid Capacity_-------------------------gals. Privy: Distance from nearest well__________________________________---------------Distance from nearest building------------------------------------------ F1Distance to nearest lot lire---------------------------------- ---------- ------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe _.. -- ---------------------------------------------------- ---------------------------------------•-- •-------------- 'L� -r,{ --------- -------------------------- ----------------•--------------------------------------------------- �---- ------------------------------------------------------------------ --------------------------------------- ----------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulatio of the San Joaquin Local Health District. ------------------------------------------------------- dor Contractor (Signed] - ] BY------------------------•----------- I---------- � ------------------------(Title)--- ------------ - ----- ----- ------ ---- ------- --------- (Plot plan, showing size of lot, location of system in relation tV wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- jr.C+! ------------------ --------------------------------- DATE----- ------------- -- REVIEWEDBY--------------------------------------------------- - --- ------------------------------------------------------------------ DATE-_-------------------------- ---•- --------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------- ----------------- ---------------- DATE------------------------------ -------------- --------------- Alterationsand/or recommendations----------------------------------------- ----- ---------------------------------- -------------•--------------------------•-------- --------------------------- -------------I-------------------------------------------- --•---------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------•---------------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------------------.--- FINAL INSPECTION BY: IA ----------- - Date. [2 SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.