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APPLICATION FOR SANITATION PERMIT Permit No. ____ .-• -`S-`�-• 1Duplicate) a` (Complete in _ - _ ` - —..� Application is hereby 'made"to the San Joaquin Local Health District for a permit to construct and in s}all the work herein described. Thisapplicatiori.is made in compliance with County Ordinance No. 549.1 ,4,.".,; . t --------------------------- - -- - - - ' T a JOB ADDRESS AND LOCAT ---------------------------- ---------- _lotr `- Own _ ------ -•----------- . er s Name_" ,�. �.. .��.,••T-•. — r..' , w --•- Y __________ _____________ c_-e____._ _ _ __ ._______ Address. e---------------------- ------- , "'" _ Contractor's Name__-' 4 mmercial ❑ Trailer Cour} ❑ Motet ❑ Other Installation will serve: " Resid ce ®,R Apart ht Hous ❑ P Number of living units: __� umber of bedrooms _ .. Number of baths _ :-- Lot size ____ `�=s -p= ; T. .L ;. ° De th to'"Water Sable"-'� 'ft-".?.r'""e v- Private ❑ p Water Supply:' Public system ® Commun ty'system ❑ Clay Loam El Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Y 3FHA/VA:Yes E] Nog No"� New Construction: Yes [ No ❑ Previous`Application Made: Yes ❑ s TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or�cesspool permitted if public sewer is available within.200 feet.) ----------------- Se tic Tank: Distance from nearest well_________.__r___Distance from foundation uid de th Notaries__-- __i_Capacity--________'__.�-._.- p No. of compartments--------------------------S'sze--------- ----- ----- q p ❑ _ s Distance to' nearest lot line.-------• �.Disposal Field: Distance from nearest well_ -`Distance from foundation_- _-I Length of. each line------- 4,r-'-- --------Width of trench:___-. - ------ Numb"er.of lines--------- ----------- g - Total length- Ty en th t s YYPe of filter material__ __ Depth of filter material___ - ------ `� x. - Distance rom f ndation__ �__i----•Distance to nearest lot' line_ ... ---------- Seepage Pit: ._Distance to nearest well-__6— �._.Size: Diameter_____ .--------.Depth__ --�- Linin material__ �y + Number of'pit - - Lining1. i F ' Distance from lnearest well_____`___:_.:-Distance from foundation___________________Linsng material :----------------------------- Distance --------------- -------- -- Cesspool: " , , . ----------------- ----- Capacity-.-.- . \I rSize: Diameter` . - = - -=---------Depth.---- = Liquidgals. ❑ - - # . ► #once from nearest building_ Privy: . .m ._.r.----_. __;__ -• --`�--"= Distance from nearest well------------- -----------------------------....-Distance from - - ------- -- - -- --------------- �, ❑ ---��- -°Distance"to nearest lot-line------'=•=--•- =-=- •---- -- if f ---- 7'--------I ---------------------- F --. ---•- •------•- 1 l Remodeling and/or.'rep'airing (describe):------- ------ -- ------- F 1 I - ------.. # ' } : F 1 4 =------ ------------- R kl _ I hereby certify that I have"prepared this-application and that the work will .be done in accordance with San,Joaquin County J � he San aquin Local Health District. t 1 ordinances, State laws, d rules and regulations o t .� Owner and/or Contractor( (Signed) -- ---------------- ----------- --- - ------- (Ti(T e�- BY (plat plan, showing size of lot, location'of system in relation to wells,'buildings, etc., can be placed on reverse side). rfi - '- FOR DEPARTMENT USE ONLY. } ------------ ---- - DATE-- APPLICATION ACCEPTED BY-- ----- DATE_ '; ----------------------------------------1- ------------- ---- ----•--- -- ---- REVIEWED "BY-------------=---- � '" 9 ----- --•--- DATE-------- ------- ------- BUILDING PERMIT ISSUED � ---- ------ •--• ---•------- --- - - ----- ! - " nd/or recommendations. Uk .-- ------------------- Al#erations W. ----- ,. .s. ----- pv. -- . . �. ,�} ---- f:------ --_-- : l ----- - -------'------------'-- __ ----- --- , --- ______ _ - ------------- -_ ---------------------_--- -- - - -- 7 FINAL INSPECTION BY..__----`. - Dafe----.4- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 30 814 North "C" street 0 West Oak Street 132 Sycamore Street i30 South American Street Manteoa, California Tracy, California Stockton, California Lodi, California ES-9-2M , Revisea 1.57 F.?-CO-