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FOR OFFICE USE; -� Permit No. .-,`-------- -------------------- APPLICATION FOR SANITATION PERMIT (Complete in.Duplicate) '�: Date issued 1 �. . --------------- ' ' Ttiis Permit Ex fires 1 Year From Date Issued d. --- ----- -- A Application is hereby made to the San Joaquin Local HealthDiNoc 549 a permit to construct and install the work herein describe Thisapplication is made in compliance ++h County Ord --------------- -�- „ESS.� - -�- - -- - ZCe4 3 � r7� - �- 1ADDE55'AND L ATION__ �, y� __. Phone___-_ -- Owner s Name------ ------ --©�-G�_�_tl__ --- - - Address--------------------- - - ---- ----------------------------------- --7v ----•----•---------•--•----------- Phone_ - ---- --------------------------------------------- --- - -- Contractor's Name_________ __ __(�_____.._____-.- •--fir- Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ �- -- Lot size _------ f �_ Number of baths �� -- - - Number of living units: _�_--- Number of bedrooms _ h to Water Table g)- ft. i Private p`�ep ` Water Supply: Public system ❑ Community system ❑ ❑ Clay Adobe ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam Y ❑ r, �o ❑ r p LJ" "'� ❑ FNA/VA: Yes Jam' " New Construction: Yes Previous Application Made: (if yes,date-------------- - - � No � t TYPE OF INSTALLATION AND SPECIFICATIONS: } [ _ t }��XR_ --- I [No septic tank or cesspool permitted if public sewer is available within 200 feet. ' __Distance from foundation_ ( ----=--Materia_____---------------C-- Distance from nearest well ___.-- _Ca acit Septic Tan : Size � �' �j,V�--Liquid depth No. of compartments____.-,�.___:--_ '- Distance from foundation_rl-Ct_-�----Distance to nearest lot Iine___L �_---1LL Disp-osal Field: Distance from nearest well_-_� --- ��________________ r 1 Width of trench-1"----- 1 �— Number of lines___! Length of each line_� �,�� -� - Total length_- � i .._De th of filter material__�1f.`--- f Type of filter material_ - -Q p 1 (�_ Distance to nearest lot F Distancetn foundation_ Seepage P Distance to nearest well ---- / ----- __Depth �. ---� 'J'�1 1 J Size: Diameter___ _ - �`f Number of pits._-�/----------Lining material__ __C t 0 g- els. Cesspool: Distance from nearest well________._.____Distance from foundation._----- Liquid_Cateacit g V' I ❑ Size: Diameter----------------- ------- ----------- De th-2------ ------------------- 4 P Y • _-_ ___.-.__--___Distance from nearest building_____..__- ------------------ ----- - Privy: Distance from nearest well----------------------------- ___-_ ---------------------------- ---------- ----------------- --- Distance to nearest lot line______________.--------------- Remodeling and/or repairing (describe):--------- . - ------------------------------------------------------------ ------------------- - - ------ ----- -- - ----------- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ I hereby certify that I have preparedts application the Sand that toaquilh work cal will be done to accordance with San Joaquin County ordinances, State I nd rules 9uat ono -- ---------------- -- - - -- istri �O ner and/or Contractor - - � --- ------- ------ -------- ------ ------- ---- (Signed)------------- �--- ----- E ---------------(Title)------ --- ------ -- ---------------- -------- I-------- Ian showingsize t, location of system in relation to;wells, buildings, etc., can be placed on reverse side). (plot f F FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY----------- ---------- - -------------- -----------'-- --------------- ------ - -- - --- DATE----- -- --'=-�--- --- -- - -------------- - - ----- --------------------------------------------- - DATE------ ----------------- --------------------------------- REVIEWED BY - --------- -- 4 - ----------------------------- DATE-------------------------------- -- - -- ----- --------- ------------ ------------ BUILDING ---- ---------------- -- BUILDING PERMIT ISSUED__----------------�------ ----- - ----------------- --------------=; ------------------------------------ Alterations and/ar recommen ations_______________________ _-_____--.__-_-_---__.------ -------------------- -------- --- ----------- --•--- FINAL INSPECTION BY:-, ----- --- �---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1601 5.kazelion Ave. � Tracy,California Stockton,California Lodi,California Manteca,California F.P.C d. f