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FOR OFFICE USE: ------------------x --------------- as i 6 ~ Permit No. .P7.�.��..1 ' --------------------------------------------------------- APK_,.:ATION FOR SANITATION PERMh, 6.y, ?7( -------------------- ----------------- --- -------------- (Complete in Duplicate) Ino S- Date Issued ---------------------------------------- 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 No. 549. JOBADDRESS AND LOCATION__?_.--� ------- �-- _.. .. ------------------------------------------------------------•---------------- Owner's Name---------C _.__r__[ -�. ------ �Phgne �� ------------ '----------- ��y - - ------ `�`.-.----- - • ' Address--------- � - f.�cp ---�------------��- _ •,,� - -- -- -- ---------------- Contractor's Name--4. �. -.---- �''' ��" ""'�" .. Phone�l� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ,�, Motel ❑ Other Ea Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size _-_ ------ -- ---------•------- Water Supply: Public system ❑ Community system ❑ Private ' Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeA Hardpan ❑ Previous Application Made: (If yes,date------ ----,--------) NoNew Construction: Yes ❑ No FHA/VA: Yes ❑ Noj3r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation----________.____--Material._.._______________-__.-----______._..__._..___. ❑ i . No. of compartments-------------------------Size---------------•------------_---Liquid depth--------------------------Capacity--•-------------------- / Disposa3 Field: Distance from nearest well—_/'_._.Distance from foundation__AV_—____-.Distance to nearest lot line__+,_________ Length of each line------ - . .--------..Width of trench.-- .-��-------------- Number of lines g Type of filter material___Ailjo:ee--------Depth of filter material_. r'.--------Total length-------ft''_�_g-----______________________ f �®._e_.-_.Distance to nearest lot line__._ f Seepage Pit: Distance to nearest well-1--a-17--------- fr m f undation__ Number of pits-- _r��-------- Linin material---je -----Size: Diameter-----Z-7---------Depth_..._A:or-3. '--------'--- Cesspool: Distance from nearest well_______________Distance from foundation-----------------_.Lining material---------------------______________- r ❑ Size: Diameter----- ---------------------- ---- ---Depth-------------- --------------------------------------Liquid Capacity------ '-------------._._..gals. �1 Privy-. Distance from nearest well--------------------_----------------------------Distance from nearest building-----------.-- x ❑ Distance to nearest lot line------ ---------------------- ---------------------------------------------------------------------------------------- ---------------------- AV Remodeling and/or repairing (describe)_________ ______ ----- -- --- "�" ' '' -------- ----------- i -----------------------------------------------•------- - -----•------------ ----------------------------------------------------------------------------------------------------------------------------------------------•---- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyp�' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------------------------------------------- ------------ ---------- --------------------------------------------- ---------------------------(Owner and/or Contractor) By:.......... ---------- 9 �4e:_- -- - ------- --- ---(Title)------ - ---....... --------. ----- (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -------------------- ------ -- ---------------------------------------- DATE-------- 1� ------------------------- REVIEWEDBY----- - --------------------------- ---------- ------------------ ------------ ------- ------------------------------------• DATE------------- ---------------------------------------------- BUILDINGPERMIT ISSUED------------------------------ -.- - -----� D TE--------------------------- -- ------------------------------ Alterations and/or recommendations: /�' �^ '�= s� ' ------------------------------------- ------- - ---------------- -------------------- --------------------------- ------------------------------------ ------------------------------ ---------------•-------------------------------• -------------------------------------------------------------------------- S / Date--------------- - -- ------------------------------ FINAL INSPECTION BY:_'__.. �/... ___-- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,CaliforniaLodi,California Manteca,California Tracy,California F.P.c O. ,