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FOR OFFICE USE: t ----------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. .C--- _ ._._.. _--- ---------=r----------- ----------- _.__.---- - '.r _ Com late 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 herin escrbed. , This application is made in compliance.with:County Ordinance No. 549. ,j;. eye-(/0_3 JOB ADDRESS AND LOCATION---- ------ -_-----.. - tX__`�----- --------------- Owner's Name------ �"j ----• •------ n ------ ...... Phone------------------------------------ y Address----------------- -- f r ! ----------- '----------------- Contractor's Name------ - c-------------------------•----------------------------- Phone = - Installation will serve: Residence bR- Apartment House ❑I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l Number of living units: I-_-- Number of bedrooms ___ Number of baths 4..._ Lot size ------_____________________________________________________ Water Supply: Public.system ❑ Community system ❑ Private L&- Depth to Water Table 20SP.7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ -_Prey; us,Application.Made:. 0f yes,date-.. ::....------..) No j2' New Construction: Yes,R' No ❑ FMA/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---s1 a r Distance from fou�nda�ion....l _j......Mateo�I--_. -....-_--_-. No. of compartments.......,2----____�_..-Size-_,S'Y-_ --F_y4 Liquid depth---5'4-_--------------Capacity._lS ` JJJ"' Disposal Field: Distance from nearest well- .5_-11.....__Distance from foundation s_/ .._____._.Distance to nearest lot dine_ ________. [ Number of lines________,i�__._____.. Length of each line- ______ idfih of trench------ Type of filter material--:JQ . __Depth.of-filter materlal_.:.1.8..........Total length...... Seepage Pit: Distance to nearest well----- .----_Distance from foundation-------------------Distance to nearest of line--..----_-.------ x ❑ Number of pits----------------------Lining material'---------.------------Size 'Diameter------.----------------,Depth--------------------------------- Cesspool: --------------------- Cesspool: Sized D ameter__- rest well-----------------Distance from foundation_-_ ...............Lining material-__--_-____---_--_.._-_.._-_____--_ p - -- -- ------ pth � ` .' L'rquid�Ca.pa�i+Y = . 92 �r,c - �+-rrn�-".—t,�-:�.�.ar•w....r- Tom'^ —+ �,.�.�-.��...� �—'--'l Privy: .. Distance from nearest well____-_ ------------ el__..__.._ --------___---__Distance from�est building---.__-_--._- } ❑ ' Distance to nearest lot line...._..- —mow"" ,[ -si ------------ !� f� ' V ------- Remodelingand/or repairing describe :----_ ' - : ' r _ ------------------------------------------------------------------------------------------------------ -•----------------------------------------------------------- ! T.. ---------- 2- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 10 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. u Q 4— [Signed) - - -�-- — =' _ _ -- __--------------(Owner.and/..or-Contracts rl,��J BY:--------------- -------------------------------- -----------------------------------------(Title)- ------- --------------------- -------------------- ---- i (Plot plan, showing size of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP, RTMENT USE ONLY APPLICATION ACCEPTED BY �r� ---------------------------------------- DATE-------- -------------- REVIEWED BY----- ------------------------------ ) 4 . = DATE BUILDING PERMIT ISSUED.------------- ` D 'T -------------- ------------ -- Alterations and/or recommendations:--../�a___o : s r�xs_-..-�- -X dl--- ---------------------------------------------------------------------- -------------------•-------------__-•-----------------------------------------------------------• ---------------------- ---------------------------------------------•---•-------- y -------------------------------------- -------------------- -------------------------•--------•------------ ------------------------------- --- ---------------•----------------------------- --------------------------------------------------------- ------------ --------------------- ------------------- --------- ------------------------------- - -------------------- --------------------------------- f_Z (:L", � FINAL INSPECTION BY:_.. -------- Date. -------------- SAN JOAQUIN'!LOCAL HEALTH DISTRICT -- 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi,California i Manteca,California Tracy,California I { 4