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FOR OFFICE USE: " ----------------- _______________________ ------------------------------- APPLICATION FOR 'SANITATION PERMIT Permit No. AA#_.r --------------------------------------------------------- (Complete in Duplicate) ------------- This permit Expires 1 Year From Date Issued Date Issued �7�_�.a---- Application is hereby made to the San Joaquin Local Health District for aper �nnstruct a�}d Mle w rk herei d s This application is made in compliance with County Ordinance No. 549, I -tx�cG�• „� �J� JOB ADDRESS AN LOCAT N____�0 7`_� r -- ------1-------- - - - ------------------------------•-----.•--------------------------- Owner's Name---- Address -- Address------------ = `... - --- ti�. t --- Contractor's Nam _ /-t' - � � ---t_1 -1---- - Phone---�"I? _ . -- � � Insfallation will serve: Residence ❑ •Aparfinent House, Commercial railer Court ❑ Mote! ❑ Ot r ❑ Number of living units: -------- of bedrooms -------- Number of aths ________ Lot size .�__ __ p . Water Supply:- Public sysfiem ❑ *Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of, feet: Sand[❑ Gravel ❑ Sandy Loam.'❑` Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application ,Made: [if yes,date-----------;._._.__} No ❑ New Construction: Yes ❑ No (�HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewers available within 200 feet.) S tc�Ta Distance from-nearest well________________Distance from foundation------------........Material--------_____...______._____.._--___..__________- No. of compartments------ -------------------Size--------------------------------Liquid depth--------------------------Capacity �l p � v p os13 eVd t Distance from nearest well _0_...._Distance from foundati 1199 _ --- to nearest lot line----�._ r Number of lines_____ __ t - �ry-�--..-_J-�_---- ____--Length of each line4 ._.Width of trench__h�J- --------------------- Type of filter materic El7LCC Depth of filter material I g Se gl Distance to nearest well_____.----------------Distance from foundation___________..__-. Distance to nearest lot line__-_--_._.._�__.` Number of pits--- ------------------Lining material--------- --------' i _size: Diameter--- ------- ----Depth--------------------------------- Cesspool: Distance from;nearest well_________________Distance from fodndation__-- _____..______.Lining material---------- .-__--__.__.____.____..__. 1� Privy: Distance from - ------------Depth-------------= ------------------------------------Liquid Capacity-- -------------------------gals. I Size:Distance well_____________________________________________.:__Distance from nearest building.._._____.____________________......... . ❑ Distance to nearest lot line_________________________ l � ` r � Remodeling and/or repairing (describe)- -----------------------------------------------------------i f F---------------------------------•-------------------------------- I ---------------------------------- --------------------- 1 - - F t, --------------------- ------------------------------------------------------------------------------------------------------------------------------- -- -- 1 hereby certify that 1 have prepared this application► and that the work will done in accordance with San Joaquin County ordinances, State laws, and rules and regulations he Sart Joaq ' Local He bistrict. t (Signed) Q F --- - - -- - -- ontract or) l By:------------------------- ----------- --------------------- ------------------- - ----- ------------ ------------- ------- le)--------------------- -- ------------- (Plot plan, showing size of lot;.location of system in relation wells, buildings, of ., can be placed on reverse side). \"J 4 FOR DEPARTMENT USE ONLY --- G6APPLICATION ACCEPTED BY__....------.e•----------- - �------------------------------------- - ---------- DATE---- - - ---��-� ---------- --------------------------- REVIEWEDBY------------- ------------- ------------------------------- ----------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED-----------' --------------------------------------- DATE-- -------- - --- - __________ __ Alterations and/or recommendations:_____ .��sG ------------ _ Y - -------- -- Z.. r_ ` 4 ________________________________'-- --- -------------- i --- / - ..Q-- - - ---- --- - -------._--------- ----------- ------------------------------------------------- ------------------------------------------k ---------------------------------------------- -------------------- -------- ----- k .;.. ---------------------------------------------- -------- FINAL INSPECTION BY:.--------.. -------•--------- -------------- Date--------. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, Y F 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1 Slockton,California ; l Lodi,California Manteca,California Tracy,California F.P.C p. Y �ti.