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FOR OFFICE USE: iAPPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) J� ------------------------------------- --------- �.__...-. This Permit Expires 1 Year From Date Issued Date Issued .5.. ...- Application is herebyFinade to the San Joaquin Local.Health District for a permit to construct nd install the work herein described. This application is made'in compliance with County Ordinance No. 549. —YO� �'�- -�---- f_ ------lacy- ..s... JOB ADDRESS ANDiLOCATI'ON .. -_�- � Cf . Owner's Name------ .r_ ,. ,- `��C$ K---------- --------------•--------------------------------------------------------- ------ Phone----------------------•------------ Address---------- - £ Contractor's Name f---------------------------------- -- Phone - Installation will serve: Residence,?9"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ■ f.4 Number of living units: -___,Number of bedrooms X... Number of baths _.__ Lot size -------------------------------- Water Supply:.'^Public system ❑ Community system [IPrivate [Depth to Water Table . K. 61 I � Character of soil to a depth of 3,feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Ly}'dardpan [� W Previous Application Made: (If yes,date- _.--_--._-.__ ) No New Construction: Yes ❑ No..Kf 'FHA/VA: Yes g�^ No Q TYPE OF INSTALLATION AND SPECIFICATIONS:I t I 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -' ' Septi Tank!: Distance from nearest well----------:'-----Distanceffrom foundation...-----------------Material...-----------------------.._....____.____.---._. l No. of compartments------------------- '-----Size--------------------------------Liquid depth---- ---------------------Capacity----------------------- 11 f le Disposal �iel.d: Distance from nearest well---4 0_------Distance from foundation--Fp.--_.-_.-_Distance to nearest lot line-.f��---.----. � � Number of lines.......!.--.--- 'i Length of each line_._ - ---.-.--.___.Width of trench';?_00---------------------------- Type of filter material. - p �e g SPG _De th of filter mater�al___.�[�___..__ dotal length .............................. Seepage Pit: Distance to nearest well___l' .__..Distance from foundation_ _.XP_._.Distance to nearest lot line.A --------- e7.,E [� Number of pits.--- Lining material___ __ ._� -Size: Diameter -_----_Depth_p ..� o Size: Diameter __.__.__-^-��_.-_-_-�4! ---Distance from foundation--------------------Lining material--------------.._____-_-------_-----.. Cesspool: Distance from nearest well___---i�,¢-----_De th`_"`.......................__._______......_...__._Li Liquid Capacity als. Pq P y------------------- -------9 Privy: Distance from nearest well_____. i_----------------------------__..___Distance'from nearest building-----..-----.._._____._________------._. ❑ Distance to nearest lot line--------- -------- ----------- ------- --------------------------------------------------------------------------------------------- 'Remodeling and/or repairing (describe)-------------4 -- ---- -- /- `�2��4Lr4e•_�-- ------------------------------` -----------•--------•--------------------------------------------------------------•-----'--------------------•----------------------------------- ------------------------------------------------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------•--------------------------- - - 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 and regulations of'the San Joaquin Local Health District. \` I Y Si ned --X�1-� ----- �r Contractor] ' A BY:-------------------------------------------------------------- ------ -------------------------(Title] - - ------- --------- (Plot -------`Plot plan, showing size of lot, location':of sy in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ,APPLICATION ACCEPTED BY------------------ - � t ------- ------------- DATE-----C7._....--�f - REVIEWEDBY------------------------------------------------------------------ ------------------------------------------ DATE------------------------------------------ -------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------–-------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------------- -------I!------------------6--------------------------------------------------------------------------------------------------------------- -------------------------- ------- ---------------------------------------------------- -- ---- ------------------------------------------------------------------------------------------------------------------------ ----- Date.... � FINAL INSPECTION BY:.--- so SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Nazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California �� < 4 3 Manteca,California a =.5 Tracy,California a li '�.