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ruK urrlc.t USt: .---------- APPLICATION FOR SANITATION PERMIT Permit No. __�_`�3 --S-- -- - ---- -------- ------------------- This Permit Expires 1, Year From Date IssuedY-316 - - - -- _ om ete in Duplicate) Date Issued Application is hereby made oaquin Local Health District for a permit tofcons ruct�n install the work }3er ' descried. + This application is in 0mpliance wi � County Ordinance No. 549. � J J08 ADDRESS A .�� -rt - ------- - --- -- r4_� __L____�.--------- Owner's Name------- -%.�---------------- --- - Phone Address _ ... _® ----------- Contractor's Nam - `r" ---------. ----- Phones -. Installation will serve: Residence partment House ❑ Commercial ❑ Trainer 'Court E] Motel [-] Other Number of living units:/--___ Number of bedroom_-_ Number of baths /_'.fit size _._ E_.K-t'e U_-------------------- Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table __Ip ft. Character of soil to a depth of 3 feet: ,Sand ❑ _Gravel ❑_ Sandy Loam lay loam 0—Clay ❑ Adobe E❑ Hardpan ❑ Previous Application Made: (If yes,date......... ..........)• No 9?--"N_ew Construction: Yes ❑ FHA} : Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public wer is available within 200 feet.) Septic Tank: Distance from nearest weli�1 s Distan�erfro i; and o _____-__.Material_ -- __.-_______- `` i uid de th-----'J -= --- ' � t No. of compartments... ._______ .-__Sizeft_?� __- G P �_-__-.Capacity_ Disppoo+sal Field: Distance from nearest we'11. _--_Distance from foundation__�Q__-_` Distance to nearest t I e�-_ J� Number of Eines__ _____ ____ _______ Length of each line-, of trench.-. ___-____-_ Type of filter materi ___Depth of filter material__,/7'/-____--Total length____ 0___--________________ Seepage Pit: Distance-to`nearest we ------�n�nq ----Distance from foundation--------------------Distance to nearest lot line-------------- Number`bf it`s-------------------- material____- _ -- - ❑ p Size: Diameter----------- -- --+-.Depth--------- - --- - -------- Cesspool: Distance+from nearest well-----------------Distance. from,.foundation_________________ -Lining!-material....... ---------------------- W Sze: Diameter---------------- --------------------De Dept ------ ,� --- _----------------------------- Li uid Capacity ❑ i - P ; - 9 ----------------------------gals. �1 Privy: Distance from nearest wet L______________________________ Distance from nearest building___-_---_--_________________.____.-._. ❑ Distance to nearest lot line-- ------------------ -------- Remodeling -----Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------- ----------------------- --- ---------------------------- -----------------------•------------------------------------------ ----------------- ----------------- _:------- --------------------------------------------------------------------------------------------------•------ 1 4 `t � -- ------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws d rulleand regula+ions of +he San Joaquin Local Health District. c(Signed) ---� q-`Y-- -- ? ( �or Contractor) g .l Y•.: - ------------------------------- (Plot plan, showing size of lot, location of system in relation to w , b '(dings, a+c can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -R 0 --- ---- - - ---------- --- --------------- DATE------ - -- ---------------------- REVIEWEDBY----------------------------------------- -- ----- ------ ------------------ ------------------------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------- -- ---------------•--------------------------------------- DATE----- Alterations-and/or recommendations------------------------------------------- -------------------------------------------- -r ---•-------------------------------------------- 1. � ') V ----- ------------------------ --- --- ---------------------------------------- --------- ---------•------------------------------------------------- -----------------•-------------------------------------------------------- - -----------------------------------------------------------------------•------------------------------------------------------------------- - L a --- --- FINAL INSPECT( al Date _.`_ S"[�C3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.