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FOOFFICE USE: � . G __..-_--___ APPLICATION FOR SANITATION PERMIT Permit No. ._ . (Complete in Duplicate) ijDate Issued This Permit Expires 1 Year From Date Issued 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 ompli ce with Count rdinance No. 549. JOB ADDRESS AND LOCATION---- - ------ ........ OwnersName---- _. 1. ___ _ __ ______________:._------..__...._ ---•------------- --------------._..-----------. Phone------------- ----------------------- Address------ :-------------•---- Address------ ?..d--_:..... -------- '--------------------------------------------_----------- = Contractor's Name---- ~--------••-------------------------- ----------------- ---------------------- Phone..--------------------------------- .:------.....a•---*--� - : Installation will serve: EResidence ' -Apartment House ❑ Commercial '❑ Troller Court [❑ Motel ❑ Other ❑ t Number of living units- I----- Number of bedrooms _7.__ Number of.;baths ---I--- Lot size ___D-5-+....X_..__1_Z_C>----------------- Water Supply: Public'system ® Community system ElPrivate E] Depth to Water Tabie(0, .f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application K4ade: Ilf yes,date--------- ) No N New Construction: Yes I& No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t I (No septic tanklor.cesspool permitted if public sewer is available within 200 feet.)4 . Septic Tank: Distance from nearest well_Vk_01'1R,__Distancj from,foundation_-___t_QQ _._:___..Material-_0 :-V;_ret------------------ _ No of com artments........ ...... _.__Size___4._?�---!_Q_ ___..Liquid de pth --_._ ____ ,-------Capacity_ Disposall Field: DisFance from ne"'rest well WOvlR,._Distance from foundation._ ..Distance to nearest lot line ` - ----- t ` 1 Number of lines_F}_-----I. -----------Length of each line----------�__Q__._�:....Width of trench...'�.�___1__________________� T �e of filter material5F7,_ro.0 k---Depth of filter material_._.__4.&_!!_1-----Total length___.___gQ__f______-_ d t Seepage Pit: «u Distance to nearest well__YLarL&._.---Distance from foundation---1.0----- to nearest lot line..-•-?�-__-._--__. p' Linin material_ p,__r_0C_ Size: Diamefe'r._4�__7�__ ...___Dept` Dumber of its i 9 S p IV---------• - Cesspool: Distance from nearest well-----------------Distance from foundation------------- --_.Lining material------.----------.---------------_-__. ❑ SizL: Diameter----I------------------------ ----- -Depth------------------- °-------------------:---t----Liquid Capacity----------------------------gals. rn Privy: Distance from nearest well----------- ----------------------____....___._Distance from nearest bui4ding-----------____----------_--.-.-_-___... DNfance to nearestflot line.:..._.. --------y------------------- ------------------ - - ----------------------------------------------------------- ------ -- - -- Remodeling and/or repairing (describe) i-------- k ------------•-----------------•------------------------------------ 9 ! ----r-------------------------I-- a,------------ - -------------------------------- ---------------------------- ---------------------------- --------- -------------------------'--------------------------------------•-----------------=='-----------------------------;----------------------------------------------------------- a i t s It 1 �: -------------------------------------- -a----------------------------------------------------------------------------- -------- ------------------------------------------ I hereby certify that I have prepared this application and that the worOwill be done;in accordance with San Joaquin County ordinances, State laws, and rules andlregulations of the San-aoagtj'in--Local Health District. k ,..-- .� v _ � {signed} ti - ------------------- ---- Owner and/or Contractor By: • -- --- ------ ----- ----------- --------- ---------------------------------------..._ ------------- ------- ------ -------- - - ----------------- (Plot plan, showing size of to oc tors of system in relation to wells, buildings, etc., can be placed on reverse side). I 4 FOR-DEPARTMENT USECONLY r �r APPLICATION ACCEPTED BY____.�__:i__ -- DATE---- .'_ _ .x-- -.7[_________________________ -REVIEWED BY------------`---------------------- ------------ -- I-------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT rISOED------------- 4 ` ---------------------: --------------------------------- DATE-------------------------------------` ----------------------- --------------------------- Alterations ----------------- Altera+ons and/or recommendations 4 0G,R � ---------------- � r --------- ---- ----------------- ---- ---- - ---------- --•-------------- i FINAL INSPECTION BY:- �. R Date -'. r _�raS._. , . `-------- ~x SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street " 124 Sycamore Street 205 West 9th Street "tLodi,California Manteca,California Trac • Stockton,California � y.California