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----- -"---"" -------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ------ ---- ------ ----- (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued <7-__a 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 compfiancetwith County Ordinance No. 549. JOB ADDRESS AND LOCATION_ "y„!'r4RAr Owner's Name_ ____"�-; Address_------- Phone --- - Contractor's Name----- -----•-� •------------------------- --•---------------•---------- ---------• -------------------------- Phone___"•--•----------•--------------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I.. Number of bedrooms NumVD.baths _1'.__ Lot size ----- Water Supply: Public s stem ------------------------------ Y Community system 0 Privatepth to Water Table ,lay Character of soil to a depth of 3 feet: Sand C1 Gravel ❑ Sandy Loam E] Clay Loam Clay [1 Adobe [) Hardpan ❑ Previous Application Made: {if yes,date------- ---- TYPE OF INSTALLATION AND SPECIFICATIONS: 1 No El New Construction: Yes El No ElFHA/VA: Yes ❑ No El (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well -fi_-Distance from foundation__-___L_�1_r__"--.Material____"- No. of compartments----`? "- Size_ °` o s-� -de k`E.-------- X Liquid depth----�..... ...........CapacitY---�- 4G DispField: Distance from nearest well__-" {9-_�-"Distance from foundation____ """--"-Distance to nearest lot line Number of lines--------- "-- ° ----""-.. - ------Length of each line--------too-------------Width of trench__.- - ---__ S Type of filter material-------�i _a___"""pep}h of filter materia------ --- ---- Total length"._.__/_O_G_- __-_- -- Distance to nearest well'___ Q(i.........Distance from foundation_____/Q_�_____,Distance to nearest lot line_,•--- � 'u ❑ Number of pits............ rest ......._Lining material--------1-CC-I.Size: �rZ_�X--lQ-°.Depth----------/,$•__�----------- El ___ _____ Cesspool: Distance from nearest woll________________Distance from foundation-------------------Lining material-__-_-______-_--______- ❑ Size: Diameter--- ------ --`----- ---<---------:bepth-------------------------------- -- --------- -- ----------------Li uid Ca aci --------gals. Privq p tY----•------------- - Y Distance from nearest well__. ----_--------- --" -"---Distance from nearest building Distance to nearest lot line_ ----Remodeling --------------------- and/or repairing (describe):_-- - --- -- - - ---- -•.------------------------------------ _' - ----�Y' - ---- iy�e{_---- --- _ _ _ _ ---------------------------------------------- I hereby cer+ify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Staalanclr,les and regulations of the San Joaquin Local Health District.(Signed)------------ ---------- ------- --------Ysfem ----- ------ --------------------- ------------------------- ----------- $Y�-------- ----- - ---'- --- Title _ -and'/or Contractor) (Piot plan, showing size of lot, location of in relaf n to wells, buifdings, etc., can be placed on reverse side). - -------FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-__-- ------- -" REVIEWED BY -- ----------------- DATE--2,-'/7 G ----- ------ DATE BUILDING PERMIT ISSUED------•------------------- ------------ -- -------------------- --------------------------------------------------- ------------------------- ----------- DATE ------- Alterations and/or recommendations:__-___".____.___-"-__--_- -- " ------ FINAL INSPECTION BY-------------/1"IL4,zt Dat ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California F.P. Lodi,California Manteca, California Tracy,California CO-