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I rvm vrril,t uot: ' -------- - ------------------- - ------- ----------------- - ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__................. f ----- --------- -------- -------- ---- ---------- (Complete in Duplicate) ' ------------ ---------------=--- -- ate Issued This Permit Ex fires 1 Year From Date Issu ---- •---- Application is hereby made to the San Joaquin Local Health District for a permit to con install the©r?k herein- -70" This application is made in compliance with C unt. _-Ordinance No. 549 Z—A/rA2746 J08 ADDRESS AND LO T! NIM zw�_. Owner's Name---- ------- -- -------------•-- ......... ------ ------- Phone � Address------- ---•--�-- t --•-•----------•--------------------------------------Contractor's Name---- - -- --------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mate`❑ Other ❑ Number of living units: �-- Number of bedrooms-- Number of baths / ` ` Lot size _ -- /- r..._ ..++�� ---------------- Water Supply: Public system ❑ 'Community system ❑ Private �epfh to Wafer Table Z ft. Character of sail to a depth of 3 feI Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan Previous Application Made: [if yes,�date-------------- -----) 'No 92-'No ❑ FHA VA; Yes ��New Construcfiion: Yes / E - No ❑ TYPE OF. INSTALLATION AND SPECIFICATIONS: f (No septic Tank or cesspool permitted if public sewer is available within 200 feet. �. � �*�. ..rte..:._ Sepfic Tank: Distance from nearest well__t�!-�_-__--Distance from foundation--/,.? -------._.Material---�d��G- ------------ 0 ..-. No. of compartments_-_--------------Sizerit±�Xtr,�f��quid depth_._ i �- --- -- ---- Capacity,lr.,G9Q------ Disposal .,�-�• Field- Distance from neare} well-aa-------Distance from foundation,,A•_"..------Distance to nearest tat line- Number of lines._'..7_-____-_ Length of each line pQ - of r xx 9 < , - �`4Width of trench.- ----------- ----------------i Seepage Pit: W 1 Type of filter m 1 eria/ ,J� _ i Depth of filter maferial� Total length � _, QQ- ------ j X I Distance to nearest well_� �_ ----_Distance fr foundation_- - c�Q----------Distance to nearest lot line_.___-.__.._ Number of pits-,_Z_____________Lining maferial__ 4 --Size, Diameter__•. Depth_�'ts'` ------------ -- Cesspool: Distance from nearest well________________Distance from foundation---_______----_-___ Lining material-_.❑ - ---------------------- 1 Size: Diameter --------------------- Depth --------------------------- - - - -------Liquid Capacity------------- -------------gals. Privy:' Distance from nearest well ____.___._-------------------------------------bisfance from nearest building------------------------- _ __ ❑ Distance to nearest lot line__________________________ Remodeling and/or repairing {describe}:------- -- -------------------------------------------- a. -------•-----------------------=--------------------------------------------------------------'-------------------- ------------------•------------------ f----------------------------------------------------- •------------•------------------------------------------------`---'------------ ----- ------- - - ---------- --------------------`---------- F I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andi regulations of the San Joaquin Local Health District, ; (Signed). -----•----- ontractor -- (Title)- ".- --------- -- ---- --- (Plot plan, showing size Of lot, locatior( of system in rel n to-wells, buildings etc—,cart b,placed on rT``-everiWsside), # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__- - ------------------------------ DATE _-- -o "� r� VIEWED BY---- -------------------------- -----! --- -- - ------ -- ----------------------------- ----------- -------------------------- ------------- A --------- -- y BUILDING PERMIT ISSUED ------- -------------- ------ ---------------------------------------------------------------- DATE Alterations and/or recommendations:`:-_:.-_.___. --------------- ( ------- --------------- ------•-------------------- --- --------------------------------------•-------------------- ------------------------------------------------ l -------------------------------------- --------- - ---- ----------- --------------------------=-- ------ ----------------- FINAL INSPECTION BY:.____....._ ~ ----------- ------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Haielton Ave, * 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,California Manteca,California # Tracy,California