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FOR OFFICE USE: _�_Q�_ �- 3.a� --- APPLICATION FOR SANITATION PERMITPermit No. 2,3_ -------------- --- ---------------------------------- (Complete in Duplicate) I- ------------------------------------ - ___--__-.__. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made fo the San Joaquin Local Health District fora permit toc�q�strucf and i.stall t e work h described PP Y This application is made in compliance with County Ordinance No. 549. l .G' ��✓ fa< `' � r:r JOB ADDRESS ANDtLOCATlO �2 -L Owner's Name- tT-- ----------- ------ Pho _- 1* ___4 :60, ....... Address ------ t ��- * �.] a Contractor's Named. �9 f Y-------------------------------------------- one. / Installation will serve: Residence �parfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms____ Number of baths /--__ Lot size ----IQ - -------------------------- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 4aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan El Previous Application Made: (If yes,date--------- ----------) No E] New Construction: Yes E] No FHA/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/4�)_O----e_Distant �rom oun gp_.-L-- -r__.M teria�.(_.:,17C,--P,-5ity- .............. ------------- - ----No. of compartments_ + _____SIZE_ rLiquid depth____-.-____-. _ _- Distance from foundation__ *_ Distance to nearest lot Disposal Field: Distance from nearest wellf---_._-----._ •.Q---- - Number of lines__________ _________ __ Length of each line----- of trench. _---------_._ . Type of filter materiae_ Depth of filter materiai____. �� ' De Total length ----------- Seepa e Pit: Distance to neare t well_.1__-1D--_-----Distance from foundation4_�? ___.Distan Distance nearest lot iine__1��,9-� p g � Depth-- � Number of its_-_. -.___- Linin material__ _- Q_�_.-__.Size: Diameter. - ---------------- Cesspool: Distance from nearest well_________________Distance fro foundation_____.____-------...Lining material.__---__________-__._____-__.__-__ S ❑ Size: Diameter------ -------------- ----------------Depth------------------------------ ---------------------Liquid Capacity- ------------------ -----gals. Privy: Distance from nearest well--------------_ ------------------------------..Distance from nearest building_____-.__-.___-----._ ❑ Distance to nearest lot line------ ----------- --------------------------- ------------------------------------------------------------------- --------------- ----------- Remodeling and/or repairing (describe)------------ -- ------ --------.- .,/ -------------------- ;1,7 ------------------ --- , it �� --------------- --------------- 'L�' r - ----------------- ----------- - ----- ------------------------- --- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, St la s, d rules and regulations the San Joaquin Loc Health District. _ - ----- t (Signed) -------------------------------------- Contractor) ----- ---- - BY:----------------------------------------------------------------------------- ---------- --- (Title)----------------- ---------- ---------- ---. - ------------ (Plot plan, showing size of lot, location of system in r +ion o wells, buildings efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- C ----------------------------------------------------- DATE------------r- - 1 ------------ ---- REVIEWEDBY----------------------------------------- - - --------------------------------- ---------------------------------------------- DATE----------------- ----------------------------------------- BUILDINGPERMIT ISSUED------------------------------U.4,------ DATE-------- --------------------------------------------------- Alterations and/or recommendations:__._____ �; /( ' -/----------�---------------------------------•---------- -----.--.---------------------------- --------------------------------- ------------- -------------------------------- ------------ - --------------- ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ - ------------------------------- ------------------------------------------------------------------------------------------------------ -------- i!- - Date---FINAL INSPECTION BY:----........--- = f/ � 1 �7� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California