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FOR OFFICE USE: --------------- /sw"7 " APPLICATION FOR SANITATION PERMIT Permit No. ....................... --------------------------------------------------------- ------------------ (Complete in Duplicate) Date Issued _ ---------__------------------------- This Permit Expires 1 Year From Date Issued Application is hereby.made to the.San Joaquin Local Health District for a pe it-to construct and install the work herein dgsFrbed� This application is made in compliance with County Ordinance No. 549. : _. •- A -- ---- -SQ- r i_PON--------- �-- 5� Mit� '-LQZO - N.JOB ADDRESS ANICU ----- SG- --- Phones- 317.7-- ----------------------------------- - ---- - `x Owner's Name- - ---- ____ ---.... ___ - Q _ .----- --- ----- D1 ----------- Address ----- Address_____________ Phone Contractor's Name---- --- - Installation will serve: Residence Apartment House ❑ Commercial ❑ _Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.�___ Number of bedrooms _� Number of baths __l.__- Lot size __ � --- ' --------- % Water Supply: Public system El-Community system•:❑ Private ( Depth,to Water Table l�rft. Adobe Hardpan Character of soil to adepth of 3 feet: Sand �Gravel ❑ Sandy Loam ❑ fClay Loam ❑ Clay ❑ ❑ ❑ ❑ FHA/VA: Yes ❑ No Previous No s Application Made: (if yes,dote__--_:__._.---____1 No New Construction: Yes t TYPE OF INSTALLATION AND SPECIFICATIONS: '(No-septic.-tanks or,cesspool_permittedrif public-sewer is-available within 280 feet.) SepticiTanlc: Distance from ea_est well-----------------Distance from foundation _____"_ Material t�...��.... :: __Capacit ----------------------- Or.F ( Size.... Li uid de th. � ❑6xA�'i'/ No. of compartments:".--�- --------------- ----------- -- q P �_-___.Distance to nearest lot line__2�_._._ Disposal Field: Distance-from�;nearest wall-•�3-_�_--___._Distance from foundation_-_ _� f r Number-of.lines___ _.__._-_ `____ ._W____'_Depth Length of each line__ Q� " -- Width of trench___ -.- r.,_-________-_.______ g s � �Type'of€filtermaterial _ _. __ of filter material ____ - Total length _ ____________ _ __ :•, 'IMT e Seepage Pit: Distance to rest well__'_ w___ _._._- Distance from;foundation _� ` -_.Distance to nearest lot line------ -------= ❑ Number�of pits-4.. Liningvmaterial-_ R'Size DiameterDepth------------------------ Cesspool: Distance from nearest well_______________ Distance from foundation-----__..._.--____.Lining material____..._.___-..________.__-_____ ❑ r ------Size'Dia'meter -- -_:---- ----------- + :Depth_ � .._Liquid Capacity gals. Privy; Distance from nearest well__.___.._____-.__._____________________________Distance from nearest building -i___. 4 ---- _ ----- r .__�.a nea,e_ , . ._ 77�--- _ �.-._.: _ ..-- - ------- ------------------------ ------------------------ . ,r.....❑,.-..,,�.,.,......._ .� ---------------- Distance to nearest lot Ene___ _- --- - ------------ ------------ --------- i Remodeling and/or repairing (describe):-- --------------------- --------------------------------------------------------------------------------------- ------------- --------- - -------------------------- ----- -------------------------------------------------------------------------- ------------------------------------------------------------------------- I hereby certify th repared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1.6vs, and rules nd regulations of the San Joaquin Local Healthy District. ----- �.V__ ----------------------(Owner and/or Contractor) (Signed)_ _ _ By:._... ------ `'`'+ �a--- --.------lTitle] Y . T (PIo4 plan, showing size of cation'of system in rclati•r�oe_6s, buildings, etc., seri be plac J on reverse side] OR DEP ENT USE ONLY APPLICATION ACCEPTED BY------ ---- (, -----f-✓��vW---------- DATE------- `�-�7=�7 -- --- DATE_ REVIEWED BY--------------------------------------------------- ---------------------------------------------------------- BUILDINGPERMIT ISSUED------------- -----'-------- -------- ---- ------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:._ `---------- ------------------ -- -------------------------------------------------•------------------ ----------------------------------- -------------------------------------------------- ------------------ ---------------------------------------- -- -- - FINAL INSP Date----------a--�- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.KaTalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street stockton,California Lodi,California Manteca,California Tracy,California f.P.co: