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FOR OFFICE USE: e ---------- ------ -------------------- M p ______________ --------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------- (Complet icate) .� Date Issued -------------------------------------------------- -- --- This Permit Expires �. om Date Issued )A41 Application is hereby made to the San Joaquin Local Health D or a permit to construct and install the work herein described. This application is�made in compliance with County Ordinance 549. (�7(p 3-1IFO z.� 11 JOB ADDRESS AND LO ON- -- --�-ot Owner's Name------- _fl7 _S_-••- --- _ t,f _ /� ----- ------------------- ---- --- ------ Phone--- -- Address... '00 ` =F ` {---� -- ----- ----------------------------------------- Contractor's Name d-�- ------------------ ---------------------------------- � ----------------------------- Phone-----------'-------- . ---------------- Installation will serve: Residence ®rOtApartment House ❑• Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms -� Number o aths �ot size a ------------- Number Water Supply: Public system ❑ Community system❑ Private Depth to Water Table a F Tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑t Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes to ❑ FHA/VA: Yes Z�-�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 2000 feet.} fLiquid =f'Se tc Distance from nearest well___ _ Distance from foundation____ QMaterialG ��c No. of compartments_____.3_.___-___._ _ Size_n/ de th___1V" Ca acit _� "--0__.___ Disld: ' Distance from nearest well_SV`____Distancb from foundation_-_��_1__.__.Distance to nearest lot line��___-___ Number of lines----------r_4___ ____ Length of each line____14W_1 _ Width of trench..*_V�!____..- ' }` --------- /l---- - -- - ---------------- fir\, f p -_ ._ -----------Total length--- _---.-- -- r } Type of filter material__-_-�,�---.___...___De th of filter material___ . � � � Seepa Pit: Distance nearest well_ 17y' 9-___Distance �;m.foundaton__/Q___2__,__.�stan etoDneepa+esttllo`$iir�e- p' __ Lin+n material_ .. _ Size: Diameier.,_.-S ` ,0k--�` Cesspool: Distance from nearest well----------------- from foundation-----------------.._.Lining material----------------------------------___ ❑ Size: Diameter----------- ------------- - - -------Depth---------------------------------- -------- --------Liquid Capacity-- -------------------------gals. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----...__.__.____.__________..._---_-__-_ " f ❑ Distance to nearest lot line............... -------- - ------- Remodeling and/or repairing (describe)------------- - k�------ �-� 1 ---------------------------------------- ----------------------------------- -------------------------------------------------------------------------------i----------m------------------------- Ja ------ --------------- ---------- -------- -------------------------------------------------------------•--- --- -- ---------- ----------------------------------------------------- --- ----------------------------------- I hereby certify that I have prepared n and fhatsthe work will be done in accordance with San Joaquin County ordinances, St a laws,a rules and re �n Joaquin Local Health District. Z., (Signed):_..-------- _ -------------------------------------------------------y:------ (Owner and/or�o�.act�?r}� i BY� - L - ------------ Title} - =! ---- --- --------- --------------- --( F,. (Plot plan, showing si o lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE REVIEWED BY ------------ DATE BUILDING PERMIT ISSUE[------� .,." " ...=F -------------------------------------------------------- - -------- DATE---------- Alterations and/or recommendations:--=--------------------- - ------- ---- --------------------------------------------=----------- -----------------•------------ ------------------------------------------------------------------------------------ ------------ --------------------------------------------------------------------I---------------------------------- ------\1., --------------------- -- ------• ------ --------------------- -----•-- -------------------------------- ------------- --- ---------------------------------------------- -------- -- -- -----FINAL INSPECTION BY:. Date - SAN .. JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street l r Stockton,California Lodi,California .I Manteca, California Tracy,California � 3 F.P.CG. {e Tia J 3