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FOR OFFICE USE: - - ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._v24 -3 ------------------------------------------------------ -- I— (Complete in Duplicate) _______________ This Permit Expires 1 Year From Date Issued Date Issued ------------------- -- ------- -------- l,,_,Date o--t 9 Application is hereby made to the San Joaquin Local Health District for a perm to co trust and '-nstal_l je work he ein described. This application is made in compliance with County Ordinance No. 549. (�t�•k �� / �-df � JOB ADDRESS CA710N h -t �� .' �. Owner's Name } S � OE�=- - �L Address-------- Q_ Contractor's(Nam - ----- Phone �!— T Installation will serve: Resi en e P Apa1.rfinent ouseCommercial E] Trailer Court [:] Motel ❑ Other ❑ t Number of living units: __I___ Number of bedroom __.1____ Number of baths 1.75--tot size ------/—_' 11------------ Water Supply: Public system E] Community system [Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sancly oam lay Loam ❑ y ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------l No ❑�New,ConsfruQion: Yes No ❑ FHAAW. Yes ❑ No ` TYPE OF INSTALLATION AND SPECIFICATIONS: [Na septic tank or cesspool permitted if publi sewsr�is.av�ileble,.�within,200:fee# Septic Tank: Distance from nearest weDistan`r #rom��fou tin__ _0_______.Materia _ _.-- ______ No. of com artments__ /� �^— -- p 2------- ------- -S�e _-�� _t _LiquFd depth-_4r�__- r�__Capacity.. o�? r le Dis osal Field: Distance from nearest well. - p:i Lance from foundation :__4�___.__._._Distance to nearest lot line__ _ Or Number of lines e___ __ ______________ __Length of each line llf _.___ ___.Width of trench.___S__��_�_..�------ 9 Length 16 ... a Type of filter materi r.Dep"h of filter material_.1�.__r�""`:To�al fengfh_-�_,✓r�'�____________�_ __ -A 6 Seepage Pit: Distance to nearest well-.------------------ Distance from foundation___:______�._____.Distanc-��o n�arest lot line------I-. ❑ Number of pits----------------------Lining Distance l---------- .-.- ----- Size I Diameter------- ------De th--------- ---------- ( t 'Yom.,, A �� • � -- P !Depth. f --foundation Lmin material ` ------- -----Li u.id--, ti ^M Cess ool: Distance from nearest well_________________Distance fro' - - g Size: Diameter---------------- --------De th= t Ca acct I als:' Privy: Distance from nearest well------- __________ '_______Dista �Ce from nearesty�uilding__ _.________.________________ ❑ Distance to nearest lot line..._._._.. .-.---_ -- -_ " "�.___.__.____ _ _ --- `` - -- Remodeiing and/or repairing (describe):-- ------------ --------'- --------- -'r------------ ..-------- --- --- ---------------- --------------------------- --------- 11 ------------•---------------------------------------- ---------------------------------------- 1 ---------- ------------------------- -------------------------- --------- ++ -------------------------------------------------------------------- ------------------ -------- ----- -----0-------v d------------------------------------ -t-_------ ------------------------- --------------------- ------ ----- -� I hereby certify that I have prepared this application and ithat the work will be done in accordance wit,h San Joaquin County ordinances, State Laws, an rules and gula+ions of the'San o� aquin Local Health District �0 (Signed)--- L c� - [, _._ ` ! �1t. Contractor] OT----------------------------------------------------------------------------------- - --- _ - -------- --- -� 1f�' -------------------------------- ------------- - (Plot plan, showing size of lot, location of system in relation o wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... .9---------------- ------------------------------------------------------- DATE----- f '� 'r- ^t�.4�-------- ---------- REVIEWEDBY------------------------------- ------------ •---------=----••------- DATE-------- ----------•-----------------------------=------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------- --------------- {--------- Alterations and/or recommendations:---------------- -- ------- - --- ------------------------------------------------------------------------------------------------------------------------- ---------- ------ -- - --- - ------------------------------------------------------------------------------------------------------------------ ---------------------------------- i ' FINAL INSPECTI - --- - - ----- --- -- Date. ..� .- SAN JOAQUIN LOCAL HEALTH DISTRICT s� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,P.CO.