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FOR OFFICE USE: --------- ---- Permit No. APPLICATION FOR SANITATION PERMIT �_ ---------------- Com late in DuplicateDate Issued _-.��=-". F ----------- 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 compliance'with County Ordinance o. 549. 9 --- s ------------------•---------------------- ADDRESS AND CA ION---- ---------------- JOB `�, 3 {' [�_ r- e ---- Phone__' Co(�--`� " Owner's Name.----------�V_77 t Address-__ --- -- -=-------•- ---- -- .{ . -- •------------- -------- Contractor s will serve: ❑ P I Installation will serve: Residence Apartment House ❑ Commercial [F� Traile� out ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms _.__-- Number of baths size _____s�_ -------- -------•---------- Water Supply: Public system ❑- Community system ❑ -Private [Depth to Water Table�� ft. Adobe._ /Hardpan Character of soil to a depth of 3 fee Sand E] Gravel El Sandy Loam❑ Clay Loam El Clay ElLr ❑ Previous Application Made: (If yes,date-.-_._________------) No �ew Construction: Yes FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d - Materia /f Septic Tank: Distance from nearest well ��-.__Distance from faun anon_.. Ca'acit _ / ®/ No. of compartments- Size--- --- Liquid depth__=_-- P Y p - 10 � Q .._....Distance to nearest lot line-S-.--__.___-. Disposal Field: Distance from nearest weill>6"�- Distance from foundation.- j' Width of firench.---__ _-"7 _-f.._.._.""---- Number of lines_ ___ _ _ Length of each line__. lP,�- ----.- Total len th----- .0----------------------- -- ------------- '-,----- Type of filter material----- -C�_:Depth of filter material- .b aterial. g S See a e Pit: Distance to nearest well/bA "mDateraal e__ m f oundS tionDi��--- -_ tan ance to.Dnep}est lo�n�=_�.:_----_- [�[ P Number of is-__. Lining p ,---------- "V Cesspool: Distance from nearest well---------_.--.-_Distance from foundation------------------- Lining material..---._.._.---------------""-- al-- s. 0 Size: Diameter- ---------------------- - --------Depth----------------- ------------ ---------------------Liquid Capacity----------------------------g Privy: Distance from nearest well-------------------------- - ---Distance from nearest building.---------------------------------------- ,.r.. ❑ Distance to nearest lot line------ ---------- ----------- --------------- ----------------------------------------- Remodeling --------------------- -----------------Remodeling and/or repairing {desci•ibe):---------------------------------------------- I -----------------=---------- ---------------- ----------- -------------- } certtf that I have pr ----------------------- ------------ ---------------------- epared this applicat------------ and that the work will be Bene in accordance with San Joaquin C I hereby ounty ordinances. State laws, and rules and egula ons of the San J aquLocal Health District. ' a ` -- - ----- ----------- - ------ -----( and/or C act (Signed)--- (Owner d/o antr or ---- --- _ t _ ------- Plot plan, showing size of lot, lloo�cation of system relation t e uildings, etc., can be placed on reverse side). Y ( P g F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_.-."'. - DATE------�-��= --------------------------- - REVIEWED BY--- --------------------------------- - - - ---------------•- ------------------- ----------- --------------•-- DATE------- - -------- ----------------- BUILDING PERMIT ISSUED------------- ------------------- - ----------------""-- ------ DATE------------------------------------------------------------- - -------------------------------------------------------------------- ' Alterations and/or recommendations----------------------- -----------------------------------------"---- - ----I----------------- --- --- ----- ------ rDate--. --- _".r1---._��--------- -------------------------------- FINAL INSPECTION BY:-.-..-.- I S N Jq UIN LOCAL HEALTH DISTRICT t 1401 E.Maieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street r Lodi,California Manteca,California Tracy,California Stockton,California F.F.C9. 4