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FOR OFFICE USE: """-""" ----"-- ------------- � CATION FOR SANITATION PERMIT Permit No. pz�� _ A� ------------------------------ --------- ------ ----- -- (Complete in Duplicate) Date Issued --------------------- -------------------------- -- -- -__--- This Permit Expires 1 Year From Date ssue Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal he work herein described. This application is made in compliance with County Ordinance No.1549. �/' ---------- ------ --------------------------- JOB ADDRESS AND LOCATION---------------1fZ11 IPhone---------------------------•-------- Owner's Name------------- /�S ' �'�� Address---------------- - - ------------ Phone, �'- Contractor's Name_ _ _______ -"-"_. t`t'.cJ l Trailer Court ❑ Motel [I Other ❑`�' � Installation will serve: Residence ApaCommercial rtment House ❑ ❑ Number of living units: ._.__ N ber of bedrooms _ - � Number of baths -____.._ Lot size __--- Water-Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. No Clay F Adobe Adobe Hardpan ❑ Character of soil to a depth of 3 feet:. Sand F] Gravel C] Sandy Loam El Clay Loam ❑ y ❑ Yes ❑ No ❑ Previous Application Made: (!f yes,date------------------- -) No ❑ New Construction: Yes [I - ' TYPE OF INSTALLATION AND SPECIFICATIONS: (Nor'septic tank or cesspool permitted if public sewer is available within 200 feet.) S �c f��k• � 9rl �. I ------------------------------------------ b Materia____._._-- - -- -------- Ustance from nearest well-----------------Distancefrom foundation------------------- - Capacity Noof compartmtents-------------------- ---- Size---------------------------------'Liquid depth r s osal F• "Distance.from nearest we _ well.............'_._,Distance from foundafion___.___.___ ._____.Distance to nearest lot line----------- Di ..-_L Number of lines---------------------- Length of each line----------------------------- Width of trench_-------------.--------. N ---Total length of filter material--------------------- __Depth of material g \ r l Distance to nearest lotu---.- I Ar a Seepa e Pit: Distance to nearest well-[�. �.---Distance fro founda#ion_ /� Depth__.ZZ IF -------- Linin material A@_ .,.N -.-- -SV,,: Diameter--_ Number of pits-`---- ------------ g Distance from nearest well----------------- from found ation__._.-------- -----Lining material----------------...._---------------- Cesspool: , , Liquid Capacity "--- -gals. c ❑ Size: Dianieter--`---- -------------------------------Depth--------------- ------------------ --------- q P Y 1 Distance from nearest building---------------------------------"------- Privy: Distance from{'nearest well------------------------ ----------- ❑ Distance to nearest lot line--------------------------------------------- -- --------------------------------------------- ------- Remodeling and/or repairing [des gibe):_.__._ _ - ----_- -------- T_ ---------------- ------ ------------------ ----------------------------------------- --------- -- I hereby certify that I have prepared this application a that the work will b done in accordance with San Joaquin County ordinances, 5ta aws, d rules a egulation of the Joe ui ocal Healt istrict. ontractor) (Signed-_ -- --- I BY la} log'- [Title) (Plot plan. showing size of ation of system in relatio w 'ldin s, a ., ca a placed on reverse side). FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY. ---------------------- -- DATE__ '- --- - -------- ---------------- - - --- ------------------------------------------------------------ REVIEWEDBY------------------- i ---------------- --------- -- - -------- --------- --------- --- DATE BUILDING PERMIT ISSUED. -- -. ----------------------- ------•------ DATE---------------------------------------- ---------- -- ----------- ---- --------- ------ ------------- --- - ---- Alterations and/or recommendations:.______.____._. _- ----------------- C ----------------- -----------------------------•-- -------------- - ._ ----- ------ ________________________________ 4 ----------------.-------------------------------------- ------------------------------ -------------------------------------- .. -----..-__....-.""--.-----._"---_--._...__._.__ - -------------------- --------- ------- ...... G---- ---- _ t- Date----------------------------------- - --- ------------------------------------- FINAL INSPECTION BY:. - - --- ------------- -- ----- ------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,califarnia Lodi,California F.P.C C.