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FOR OFFICE USE: 3A6 2. C� Cr'IV CA, !-z- \ ------------------------- ---------- --------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- ------- ----------------- ........ (Complete in Duplicate) �� ----------------_--_- ::._-_---_-___:_-_-.-_-. -.-_- This Permit Expires 1 Year From Date Issued Date Issued __--_------ Application is hereby made to the San Joaquin Local Health Distric.#or a permit to construct and install the work herein des ribed. This application is made in compliance with County Ordin ce No 549. /zGG� JOB ADDRESS ANa LOCATION Owner's Name------ --.C�t ----- -------•-----G,L.I -------------------------------- ------------------------------ ------------------------------------ Aciclress �® -=-_ ------------- Vis+!-�---- 41_t�,T-2_ ------ -•-•---- ---- - - 7--------------------------------------------•---p--------------Contractor's NamNJ e Name_.. .._ ----------------------------------------- Phone.lAx.!_" Installation will serve: ResidenceofApartment House Commercial E] Trailer Court ❑ Motel [:] Other E] Number of living units: --/-- Number of bedrooms j--- Number of baths ---,1`_ Lot size ------ -------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _-._--_- ft. r Character of soil to a depth of 3 feet: Sand [-] Gravel ❑ Sandy Loam ❑ Clay Loam El Clay 1771 Adobe Hardpan E] W Previous Application Made: (If yes,date--_----- --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic to k or cesspool permitted if public sewer is available within 200 feet.) i Se~ To Distance from nearest well-----------------Distance-from foundation--:_.---..-_--.....Material_----_-----------------------------------__---- c No.. of compartments_----------- --------� Size---------------------------...Liquid dept'----------------- -------Capacity-•-•------------------ Dis osal F '(d Distance from nearest well- D_-._Distance from foundation-._----/0-_---;-Distance to nearest lot line----- .... ��Number of lines-.--__- -_ -_-_ A_______Depth Length of each line--" 7-V �_____________Width of trench--_-_pZ4 '-----_-_--_.-_ Type of filter materi, -Il - _-_Depth of filter material____-__--1p_ N -Total length--------i!0-_-----__._..-__-- (� l Seepage Pit: Distance to nearest well.------------ ___.__Distance from foundation______-----------__.Distance to nearest lot line----------------- j0 ❑ Number of pits_.._--_----_----_.-Lining material-----------------------Size: Dia.!meter-----------------------Depth__--------_----_----------_---_ Cesspool: Distance from nearest well-----------------Distance from foundation------------ -__.Lining material-. -_------- ------_-_--_----- ❑ Size: Diameter--------------------------- -----------Depth----------------------------------..--:._...r..-f---.Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------.------Distance from pearest building_____-_---_--.---__-__-_--._.-------.- 1. ❑ Distance to nearest lot line - - ---------------•------------------------------------- ---------- Remodeling and/or repairing (describe:- ----- - ------------------ ----- - ------ -----------••-•-----•-------••------------------------ ------------------------- ------ -- - ------------ -- --------- ---------------- - ------------------------------•---------•------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby r ify that I have prep this application and that the work will be done in accordance with San Joaquin County ordinances, S t laws, and rules an r ulations of the n Joaquin Lo Health District. (Signed)_ u� ) --- --------------- ontract ------- ----- ------ ---- ---- - BY� ----------- (Ti+le) --- 4e -11--- ----- - ---- --------- (Plot plan, showing size of lot, Iocation of system in rel to weIIS. build' s, etc., can be placed on rev se side). FOR DEPART E T USE QNLY C� APPLICATION ACCEPTED BY--------------------------------- ---------- - = --------- DATE---- c =�� f----------------------------- REVIEWEDBY -------------- - ----- -------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------- -----. DATE--------------------------------------------- -----•-•------- Alterations and/or recommendations---------- ------- ------------------------- -------------------------------------_------------------------------------------------------------------ -------------- ------------------------ ------------------------------ ------------------------------------- ---------------------------•----------------------------------------------------------------------------...- -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- -------------------------------- --- - ----------------------.._.. --------- ---------------- -------------------------------------- ------------ -------------------------------------------------- Date ------------------------------------------------ FINAL INSPECTION _. Date---- - ---0 Z-- ------------------------ ------------------------ S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.