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FOR OFFICE USE: - -- --------------------------------------------------- -- ----- ------ -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... .l... -- ---- --- -------- (Complete in Duplicate) � 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 constru© ndinstall to woherein d scrib'd. This application.is-made.in.compliance with County Ord'lance No. 549. f ` �, JOB ADDRESS A DLO ATION � t 11�1 JAZ Owner's Namen '` ----- ---- Phone..Address-----•-----------• l (/ ' Contractor's Name----- `l ------------------- Phone---------------.._................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___._ Number of bedrooms __ Number of bathsca�./Lot size ____ �� 4__e___________________ Water Supply: Public system ❑ Community system ❑ PrivateEJ-IJ7e-pth to Water Table._ _- ft. Character of soil to a depth of 3 feet: Sa€d [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardp I] Previous Previous Application Made: (1f yes,datek. ___-_--- -) No �ew Construction; Yes No [IFHA/VA: �NYes Wo El TYPE OF INSTALLATION AND SPECIFICATIONS: `' (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) k _ Se tic T Distance from nearest well_ .- _ - _Distance froT foundation_ ___� Material �(L � ~ p --- 1 ----- ------------ ��- No. of compartments_. - Size________ _____________ _ _ ____Liquid depth_ _ a acit _d___-:I I - '� nth _ /y p y----/, a Disposal d: Distance from near st ell_. ------Distance Distance from fourdation-- -----------Distance to nearest lot line_.:__-----------"-N ..�_.. �.._ Number of lines___-____. __j Len th�of each lineWidth of trench.- - -_�� // p - f> g -------------- r -Type of filter material____ __ .�_ - ____De th of filter material---. __ ._ � Total len th_��_________________________ �. ---------- Seepage P• . Distance to nearest well_`�_10t-..__Distance -fP m foundation__-1-14________ .Distance to nearest lot line______-______ 10 Dill, Number of pits--__ _______-_Lining material_ __.prt ___. Size: Diameter. __.f.-___Depth_c_).-4___I__1.2 ___ . J Cesspool: D'istarce from nearest well-.---------------Distance rom foundation__________ _______Lining material------------------------------------- ❑ Size: Diameter----------------- -----------------_De th----____'-- -- ---_Li Liquid Capacity- p �- -------------------------------- - q ----------------------------gals. Privy: Distance from nearest well-______________________________ -----------------Distance from nearest buiiding___----_____--_-_______-__----_--__--_--- ❑ Distance to nearest lot line- --------- - --------- --- - --------------------------------------- = Remodeling and/or repairing (describe):------ .Q-- ---------* Q ' -------- - .-, --------------------- - -- ---- -------------------------------------------------------------------------------------------------------------------------------------------- ----- i ---=----------------------- ------------------------------------ ---------------------------------------------------------------- ----------------------------------------------------------------:------------ ! hereby certify that 1 a`-ve prepared this application and that the work will be done in accordance with San Joeguin County ordinances, State lawj;f rules and a tions of the San Joaquin Local Health District, f (Signed)----------------- i - -- --`--- -------- --------- ---- --------- ------(Owner and/or Contractor) By:-------------- ,.. �----- '� ! �` r_ " ��,,��.,, Title Plot 1lan';-showin 4tz of lot.-location of system in relation +6 buildings, etc.;can{be']laeed on-reverse side ( p g Y g P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------------------- - T4DATI REVIEWED BY --- ................ --- . . --- DATE a BUILDING PERMIT ISSUED-------------------------------- --------------------- -- -------------------------------------------. DATE---------------------------- ----- -------------------------- Alterations and/or recommendations:__________________ -1. --------------------------------------------------- ------------------------ ----------------- ------------------------------------------------------------------•----:-=---------------------------------------------------- - --------------- ---------------------------------------------- ----------------------------------------------------•------•----------•--------------------------------------------•- ---------------------------- ------ - -----•----•---------------------------------- ----------------------- ---------- --------------------------------------------------•-•------------ -------- ------- ---------------------------------------------------- ---------=--------------------------------------------------------- - - --------------- --------- ......... ----------------------- ---------- ------------------------- ------------- ---------- FINAL INSPECTION BY Dafie__Q..... _�_ ------------------------- SAN r SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1401 E.Hazelton Ave. 300 West Oak Street tir 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California