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FOR OFFICE USE: �.��--�-�--- -------------------------- ----- --------------- _________ __ APPLICATION FOR SANITATION PERMITPermit No. ----------- ------------------------------------------ (Complete in Duplicate) Date Issued --------- ThisThis Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the�workk herein described. This application is made in compliance with County Ordinance No. 549. r cora' _ 7.42 JOB ADDRESS AND LOCATION_____ ,.�aa,a_-- -� -h '• _�- _ ' ' I Owners Name---- _ _____"------ - - __________ _ ____-_ ___ _________--__ ._____ " Phone- ' Address �` p -- ------------------------------------------------------ ---------------------------------------•---- --- --------- ,------------------- - - _ i Contractor's Name-- •c p.. ---- {--" -`��"-_ ❑ Installation will serve: Residence T, Apartment House F1 Commercial Commercial Trailer Court [3 Motel C3 Other Number of living units: _-I__. Number of bedrooms___ Number of baths _-.-____ Lot size ____ __ Community system ❑ Private [Depth to Water Table .------- ft. Water Supply: Public system ❑ Y Y Clay Adobe❑ Hardpan Character of soil to a depth of 3 feet: Sand F1 Gravel ❑ Sandy Loam F1 Clay Loam ❑ij Y ❑ No ❑ Previous Application Made: (if yes,date__----------------) No F1 New Construction: Yes ❑ No [IFHA/VA: Yes ❑ -.TYPETOF INSTALL.ATI.OWAND.-SPEC IEICATIONS: "(No septic tank or cesspool permitted if public sewer is available,within 200 feet.) r • Septic ank: Distance from nearest well___.S�' ---Distance from foundation__--__1_Q_-_____-.Material_._.______ - ---- ,T p ' ----Capacity_1lp_oG_ i y❑/ No. of compartments-------- ----.-.---Size_ _.�--- ---- ___Liquid de th-----' ------------ i Dispos F"sell: Distance from nearest well- '�pl-.-.Distance from foundation_____1.Qf------Distance to nearest lot line_!'.------.- Len th of each line--_--f_ -�-............Width of trench_--- `------------------"---- Number of lines------------- 9 ` Type of filter material-____--_ t_fZ_c_ ---Depth of filter materia --- on 11-------- length...... -ap ------ i , Seepa a Pit: Distance to nearest well-.-.--t G�tn_1----Distance from foundation--__1_t'1_____._._ Distance to nearest lot iire____.��._-____.- Number of pits.------- `------- Lining material------5",-JL,__-.-Size: Diameter------3-3--'*-----Depth_-�'---------------- Cesspool: Distance from nearest well_________________Distance from foundation---._- __--.-_.----Lining material------------------------------------ Li uid Ca acit gals. ❑ Size: Diameter--- ------ -------------- -- --------Depth--------- -- ------- --------------- Distance ------------ 9 p Y - - 1 from nearest buildin Pricy: Distance from nearest well--------- ------------------ ------ - -------- ------------------------------------------- Distance❑ ---------------- ------- to nearest lot line_.___.".._.___-- r---'---- ----- --- ------------------------------------------ ------------' - ------------------------------ ------------------------- Remodeling and/or repairing (describe) *. ---- ----- ------------ ------------------------- ------------- ---------------------------------------------------------------• ---------------------•-- ------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared..this a lication and that the work will be done in accordance with San Joaquin County ______ __ pp q Y - q Health District. { ordinances, 5 at aws, and ruie�nd•re�ialations of the San Joaquin Local He 'and/or Contractor) -- --- --------- _ (Signed)_ - _ ._- - _ t Y --- ------ --A---•-- - - --- -------- -- - - - ! (Plot plan, showing size of lot, location of sys m in relation to wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY DATE--- /- �---- ---- ----------------- APPLICATION ACCEPTED BY------ "------- ---------_-_ ----- ----- -------------- --- DATE----------------------------------------------------------- REVIEWED BY. - DATE------------------ . --- ,.:�,---�--,-- ------� ---------� BUILDING PERMIT ISSUED — —.�-� --� - - --- ALtarations and/or recommendations: wzr_ , - . ------------ - ---------- ---------------------- -- ------ --------------------- FINAL INSPECTION BY:_ ------------------- SAN ------------ ----SAN JOAQUIN LOCAL_ HEALTH DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO-