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FOR OFFICE USE: ---------- -- o 3.> APPLICATION FOR SANITATION PERMITNo. Permit ................. ------------ ----- -- ---------- ------- ----------- - -------------- ------ ----------- ------------------ (Complete in.Duplicate) Date Issued A ---------------------------------- ---------------------- This Psiernit Expires I Year From Date Issued A San to construct and instal�the work herein described, T�plicafion is hereby made to f n Joaquin Local Health Distri&'for a permit oe 0- 0 's Application is made in compliance with County Ordinance No. 549. ,�:cf_3 1 S;- _T-A-c-r_---V -,ej , JOB ADDRESS AN&C�TION...,__T----- - - ---------I-----------O-W-----------------------•------------ Owner's Name '!/l@l --------I------------ 1 ------------------------------------------------- _47 Phone---- Owner's Na ------ oxz -------------------------- ------4�---------- Address-------- - --- ---- 4 -------111; L ------------- --- -----_--------- ------------ Phone.e;� Contractor's Name '----------------I _1� - r�_�-------------- V) Installation will serve: Residence Apartment House El Commercial E] Trailer-Court E] Motel [I Other [3 Number of living units: -------- Number of bedrooms Number of baths __a7 Lot size ------1:52 ---- ------------------------- Water Supply: Public system [I Community system d Private [K r Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: :.Sand E] Gravel E] Sandy Loam Ej Clay Loam ❑ Clay El Adobe Hardpan ❑ Previous Application Made: (if yes,date------------------ -) No g New Construction: Yes No E] FHA/VA: Yes E] No 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-.-75-__-__Distance from foundafion_./A_'f--------Material--- --------------- -19 5V ❑ No. of compartments---------A------------Size-0-AW! Liquid depjh----_,4...............Ca pa city.. P--___ Disposal ----- Disposal Field: Distance from nearest Distance from foundation......R_ .-_3---------Distance to nearest lot Iine_A?5?'e__. * -7,fp-l'.�Vidth of fre,,H-- Number of lines--------- V-- -----------------Length of each line IV Ty'e.of.filff�rial-----/gf__A�r�epth of filter material---_A? . ......Total length---------Q_ P . I ;ko---- -------------- er material —--------------- Seepage Pit: Distance to nearest well- ,______________Distance from foundation-------------------Distance to nearest lot line__-_______-___-__ s -----------------------Size: Diameter----_------------------Depth--------------------------------- E] Number of pit- ----------------------Lining mate Cesspool-, Distance from' nearest well-----------------Distance from foundation-------------------- Lining material------------------------------------- ❑ Slie: Diameter-------------------------------------Depth---------------------------- ----------------------Liquid Capacity----------------------------gals. Privy:-Jk. -Distance from nearest well_________________________________-__--_-------Distance from nearest building__--_-________-______________-'-_-- t Distanceto nearest lot line-------------- ---------------------------- ------------------------- -------------------------------------------------------------------- Remodelingand/or repairing (describ, ------------------------- ------•-------------------------------------------------------------------------------------------------------•--------------------------------------------11-1---------------------------------------------------------------------------------------1-1-------------------------------------------------- --------------7---------------------------------------------------------:---------- -------------------------------------- -----------------7-------------------------------------------------------------------------- ------------------------------------------ -------I------------------------------------------------------- -------------------------------------------------------------------------------------------------------- - - 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, and rules and'regulations of the San Joaquin Local Health District. (Signed)--- -- -- ------------- --- ----- ----------------- -------- ------------------------------------------(Owner and/or Contractor) ----------------------------------------------------(Title)----- -- -------------- - -- -------- (Plot plan, showing size of lot, location of system-2'_; By:------- relation to wells, buildings, etc., can be placed on reverse side). 99DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------- ------------------------------------------------------------- DATE----l -------- ----------------- REVIEWEDBY----------------------------- ------ ---- - ------ -- ------- ------------ ----------- -------------------- DATE_---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------------ DATE_----------------- _-------------------------- -------------- Alterationsand/or recommendations-- ------------------------------------------------------------------------------------------ ---------------------------------------------- --------------- -------------------------------- ------------------------------ -----------I------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------:,=--------------------!------------------------------------ --------------------------------- --------------------- ----------------------- --------------------------- ------------------------------------ -------------------------------------- -------------------------------- --------------------------------------------------------------I-------------------------------------- -------- ---------------------------------------- - - ------------------------- - -- - ------------------- -------------------------------- ---------------- -------------------------------------- -------------------------- /A ---- 4 FINAL INSPECTION BY:_____._ ----------- --------------------- Date_ -------------------------------------------- N J AQUIN LOCAL HEALTH DISTRICT 1601 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California .6� ",ro 3M 3""