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e t�rri�.e W)L:1._.__...y. .............. ....... APPLICATION FOR SANITATION PERMIT Permit No. ..Zf7L �.... ----------------------- --------------------------------- (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 permit to construct and install the work herein described. This application is made in compliance with County Ordinance# No. 549, JOB ADDRESS AND LOCATI t .6�-- - ----.-----!��------ Q�� Owner's Name--p �--!---- -'r +� _>la ----------------i---------------------. Phon 40--/!73_ Address-------------%-A' l- -----------/� r----------- ' `- ------------------ Contractor's Name !" + .�r 'r-=------------------------- --------------------•-------- Phone�t14 ---- Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ units: _ _-7-0.7f q I Number of living �.____ Number of bedrooms __�.,_ Number of baths _�_____ Lot size _�_�.�__..�____J__1•-_ --__________________ Water Supply: Public system ❑ Community system ❑ Private OZ Depth to Water Tableted ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam g Clay Loam ❑ Clay E❑ Adobe 5Z- Hardpan ❑ Previous Application Made: (If yes,date....................) No K New Construction: Yes ❑ No V FNA/VA: Yes ❑ 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-----------------Distance from foundation----------------..-.Material--------------------------------------..---_.-_ ❑ No. of compartments--------------------------Size--------------------------------Liquid depth---------------- --- ---- Capacity--•--- ----- ------ Disposal Field: Distanci fret well. "IfV� istance from foundation__6_6 .Distance to neare blot Ii I- ------- - ►___ [� Number o lint' es__ _ _ W-j_1.-Length of each line-----1,�_�-___,__.-.Width of trench_.--- Type of filter material l._ �� yp materials.1.42,04/k/__Depth of filter matErial__._./_�._____.._.�ofial length---------/�'__ Seepage Pit: Distance to nearest welf----------------------Distance from foundation----._..-----------.Distance to nearest lot line__._._____.___ ❑ Number of pits-------------- -------Lining material-----------------------Size: Diameter------.----------------Depth--------------------------------- .00.0 Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------------------------- �9 ❑ Size: Diameter--------------------------------------Depth------------------------------------ ---------------Liquid Capacity---- ---------------------gals. Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building---------- __-_.____-_-____-..-..-_____. v ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------- ----- -------------------------- �l . Remodelin and/or re ayin (describe}:-------- D GS=- ' 'C��-------s�S� ------- i ---- r, .. J --------------------------- --------------------- ------------------ ------------------------------- -------------------------------- `` t ------- __ ----- ---- . ---------- ---- ----------------------------------------------------- I hereby cer ' that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta I s, and rules and reg i ns of the San Joaquin Local H"Ifh District. (Signed)_______ __ K_____ A wner and/or Contractor4 -------- gY:---- ---- -- -- -- ---- --- --- ---- --- -- -- -------------------------------------------------------(Title)---�-- --*-------- - --------- --- - --------- ----- (Plot plan, showin size of lot,�ocatiion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--. DATE. -�- REVIEWED BY------------------------------------- ------ ------ DATE------ -------------•-- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------- ----- - ----- -------------------------------------------------------------------------------------------------------------- ---•-•------------------------ ---------------------------------------------------------------------------------------------------------------------•------------ ------------------------------------------------------------ ----------------------------------------------------------------------- -- -------------- ----- ------------ ----------------------------------------------------- -------------------- -- -------------------------- FINAL INSPECTION BY:.. _-, -— . - -------� Date-----��_- / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California