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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------- A --------------------- ---------------- (Complete in Duplicate) OZO ------- --- ------------------- This Permit Expires 1 Year From Date Issued Date Issued ./ K- 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. JOB ADDRESS AND LO ON----- � r��'_�- ---------------------------------------------------------------------- { Name ------------------- Phone------------------------------------ L�- ------------ ------------------ --•--•----------------------------------------------------------------._..AAddess - Phone----•- ------T Contractor's Name------------ �-Z� � ..----------------- ----- -------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial;❑ Trailer Court ❑/ Motel ❑ Other ❑ Number of living units: )------ Number of bedrooms__. -- Number of baths j4::_ Lot size P- _-. _ -- - - Water Supply: Public system ❑ Community system'❑ Private [ epth to Water Table - ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Or-Hardpan ❑ Previous Application Made: [If yes,date.-------------------} No Eq`�New Construction: Yes o ❑ FHA/VA: YeuRr'-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: d (No septic tank or cesspool permitted if public seW er is available within;200 feet.) I �i�✓------------ Septic Teak: Distance from nearest well___------_IDisfance from foundation___ ________-------- tenal____� -..--- .-.--.. [� No. of compartments.-----"?.___ � Liquid depth • Size._ � L�.* q p� -----.-Capac�ty..l_att�0----- j Disposal Field: Distance from nearest welil __Distance from foundation----!_---------Distance to nearest lot Number of lines----------------- 1Length of each line------------------------------Width of trench-!��V-��e------------------ 4P'11�- of filter material____ jj�' f_ "Depth of filter material---/_f_ft-------Total length-__ c --------------------- ----------- ______________ Seepage i : Distance to nearest well-----/�----_.`__-Distance fxQm foundation--/A_f______-Distance to nearest lot line -----j- Number of pits_..___- ______Lining material__. _W:-- Size: Diameter -'�.-____--Depth_____ ---- --- - --- p Distance from foundation---------------.....Lining material_.._..-_____.--____.______-_-______ Liquid Capacity als. Cess❑ool: Distance from nearest well------ --_-- _N Depth--------------------------------------------- q p y----------------------------g J Size: Q�ameter----- - --=---------------- - �--=._: Privy: Distance from nearest well---------------------------------- --------------Distance from nearest building---------------------------------------.-. Q Distance to nearest lot line------------ - 1"�� IHC Remodeling and/or repairing ___.-._._ -----�� -----/-,�-�-----� -sl---�"= ---------•-----------------------• f M ----------------- - -------------- -I----------------------------------•-----------------------------I---- ----------- -------------------------------- --------------------------------------- -------------------- I ----- ----I hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County, t ordinances, State laws, rtt r s; and regui of the San oaquin Lo6l Health District. (Signed) -�= ------------------------------------------ --- -------Owner and/or Contractor)t , , S By:----------------------------------------- -- ------- ---------------------------------{Title) ' '- ------ ---- - ---------------- (Plot plan, showing size of loft, tion of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- - ----- ----------------------------------- DATE -a f--------------------- -- ---- -- - REVIEWEDBY------------------------------------- ------- ------------- ---------------------------------------- DATE-------- ----------------------------------------------- BUILDING PERMIT ISSUED------------------------------------- _ - DATE.------------------------------------- ---------------------- Alterations and/or recommendations:--='>_-r_ _----�J= --_- = ------------- _ ---- "� -J----- ................... ---------------- ---hfra ---------------------------------------------------------------------------------------------------- - -------------------------- r ------------------------------------- E FINAL INSPECTION BY:... __.-- --- ------ � �'�� - Date--------- - f.-.. -- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ? `} 300 West Oak Street 124 Sycamore Street 205 West 91h Streets , Stockton,California Lodi,California Manteca,California Tracy,Colifornia F.P.co.