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FOR OFFICE USE: =o� -------------------- APPLICATION FOR SANITATION PERMIT Permit No. " "- (Complete in Duplicate) Q �6 # Date Issued -7--- ...........--- --------------------------------------pp -- 4- I�^� � his Permit Exepiires_1 Year From Date Issued Application is herebymade to.: he;San. oaqu�rrLocal E lfh District for a permit to construct and install the work herein described. This application is mad;ln"ompliance'with Cou ty Ordinance No. 549. •Ill •`r •`� ['�,�� `�/'�f`' JOB ADDRESS AND.LOCATION- - -- -- ----,--------------- - ----------------------------- Owner's Name--------„ � - .--1------------------------------ ---------�------------------------- --------- Phone----G� .7--- . Address-------------------- c ---G'--- / �/ /,�� C_ 1/ -------------------------.._--------------•----------------•--•---- Contrac�ar,'s Name - - - --' ----.--J-- -tr:s!r'� Phonefy�' Installatijn will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ (umber of living-units:;rNumberYof bedroos-,L—Number o baths __ Lot size _ �. �� ___________________________ Water ply: Public(system El Community systemjK Private [:] Depth to Water Table �_ ft. Characer f soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand=CLo il El Clay Loa F1 .Clay [I Adobe M Hardpan ❑ Previou�s-,1,4 Application Made: {1f yes,date________________L leo Q New Construction: Yes F' - No ElFHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank*or cesspool permitted,if,public ewer,is available within 200 feet.) yr � `- Septic Ta k: Distance from nearest well_________________Distanile from f ndation_-___--_---_---__--Material-----------------------_--.--_______.__.._______- ❑ No of compartments---- ------- ---- - ---Size---- -------------- -------- Liquid depth - Capacity --------•-- f � �+ , Disposa ' geld Distance from nearest we")1 -��t!'D, ance from foundation___._!��-----Distance to nearest lot line__,�f�___- 00 �5 Number of lines------ --___l_____..__.,__ ____Lengthiof each line------,�O ________..Width of trench___.____ '_..______._ rl ie 6 Tye of filter mater( -_- _____Depth of filter iatenal--__.�-_-_-----.Total length-----------��__ ___________________ m Seepag Pit: Distance to nearest well- ---_--_----Distance fro fou dation_-__ .___.Distance to nearest lot line_-. �___._ .sr.; Number of pits------ Lining material___oO _.Size: Diameter._.__ __-;�...3_...___Dept h.......Zr_��__ '_____________ Cn Addikl'vnnl I I 11k esspool: Distance from nearest well-----------------Distance from foundation-_-__-____- _Lining material ❑ Imaterial---_-.__.._._...____.__.___._____ __._' C -----------gals.Dameter--------------------- --- Depth .----------..sLi ui� aa Yr•------------- Privy: ! = Di§tante from nearest well-------------------------------------------------Distance from nearest building_________.________________________..___.. Disfance to nearest lot line.. . - -------------- - --------------------- ------------ Remodeling and/or repairing.(des ribe): _-___-- t�------ -- --- -------------------•----------------------------•---------------------------------------------------------- -------------- --------- ---- ---------------------------------------------------------------------------------------------•------------------------------------ --------------------------------------------------------------------------------- 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 d regulations of the San Joaquin Local Health District. (Signed) ----------- -- --- _---(Owner and/or Contractor) BY� -- - ----- -- - --- ----------- ---------------------------------------------(Title)-------- {Plot plan, showing size of lot, anon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --------------------------------- DATE__.__Q_aa�9--__----- REVIEWED BY----------------------- DATE--- BUILDING PERMIT ISSUED_____________________ ________ ___ _ DATE...... . ------------------ - A Alterations and/or recommendations: _ J ------- A ___ -- � ----------------------------------- t - --------•---------------------------------------------------------------- rF ------•--- �------ ---- ------- - (f" r 1 ...-------------- FINAL INSPECTION BY:- - �I��.4I ------------- Date------------ -- ------ ------�---1--�°-1-l-- SAN �1 JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 C.