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FOR OFFICE USE-. ------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------- (Complete in Duplicate) �I-S� 5 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. I JOB ADDRESS AND LO ATION------------------ -Q6------ /�� / ------ /} Owner's Name.--------- / � _l_(' _- -------------- -- - Phone,41J. -- Address--------•---------_----------� (� ��•---- ��Q�`Z� .r --I/v f----------•-•----------•-------------------••-----------------------.-.----------.. j - -. P Phone._Contractor's Name_______________ _ Installation will serve: Residence ��artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/_ Number of bedrooms ---- Number of baths _/ -Lot size __. .� --.x.----.fes ------------------- Water Supply: Public system ElCommunity system El Private � /"pth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam [Clay [j Adobe E] Hardpan ❑ 1 <- [KNo ❑ FHA/VA: Yes No Previous Application Made: (If yes,dare.............. ) No New Construction: Yes ❑ ❑"� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool,permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well Distance Yfrom foundation__� _._. ...Materialf__L t _��, _ -__-._ of compartments _______ _____Size___io - _ __-.__--Ca acit /; p �-_ �/�'---�----Liquid depth__.-�- ------ P Y------------------------- No.Disposal •elcl: Distance from knearest ell...-75_f-Distance from foundation----� ----------Distance to nearest lot line_. -- ------- -- - aj`S / Number of lines--------- -------------------Length of each line--- - ------__-- idth of trench-- �� Type of filter mat eriaL_,=✓` k�� :-Depth of filter mate rial., _ '____----Total length---- 7� =----- 6 Seepageit: Distance to nearest well_,_Z ,0_-"I_Distancefr found _ - - ation__ t Distance to nearest lot line- f�__._- Number of pits._.___-_ __-__Lining material_ 4_';e..Size:.Dia met rU Depth----- _--_'-_.____.-_--- j Cesspool: Distance from nearest well-----------------Distance from foundation-_-.---------------.Lining material__._-------__-.__--.-____._____ -- ❑ Size: Diameter--------------------------- ----------Depth---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well_____________________-_____.___---._.-___- -.-Distance from nearest building-__._-._--______-_----_-_-___-___-__-. ❑ r •, nearest lot line.-.-._ ----------- Distance to n Remodeling and or repai[ ;(describe -- G _ C�,.----- ---�g-! --� `/� - � 7 Z �, - �C�-L t `------------ � j'za - r ------ ------------ ----------------- ----------------------- _ ____ f�1 G' -��'--------------------- ", -- ----------------------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Y I ordinances, State laws, an es}and regulations of +he San Joaquin Local Health District. 07 - w and/or Contractor t (Signed)------------------------ - - gY=-------------- ---- - - {Title) ------------ ----- -- ---- --------- (Plot ---(Plot plan, showing size o lot, location of systA in relation to wells, buildings, etc., can be placed on reverse side). f t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS© 13Y �- ------------------- DAT E-------`��-`��-•��-- -- ---- --r ---- - --------------------------- REVIEWED BY- ----------------------_--- ---- --- DATE BUILDING PERMIT ISSUED--------------------------------- - ---- - ------------------------ -------- DATE----------------;----------------- - -- . c -- `-•- .�_=� `----------------------------------- -- ----- Alterations and/or recommendations:--___-.- - -------.-. ��_ / "� �1 CC-------------------•-----------------------•---------- ---------------------------------------------------- ------- ------------------------ - ---- FINAL INSPECTION BY:--- ---- ------- ----------- --------- Date -y SALOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 W 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R.CO. 1