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FOR OFFICE USE: ,I� i1,P.3�-?- _ APPLICATION FOR SANITATION PERMIT Permit No. . �--------------- - - (Complete In Duplicate) J]. ............----_:,-_---------.------.__________._.�._..__ This Permit Ex ices 1 Year From Date Issued Date Issued ___-_--_1-r---- P 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 irii'compliance with County Ordinance No, 549• I� Ll V JOB ADDRESS AND LOC-A N .- ! /�� --------- '"-------• ". ill Owner's Name---141........ ` Z----------------•-•---------------------- Addressu � ------------------------------------------- -------------------------------------•--••------------------------••----•---- p f -d Contractor's Name �U�� J_Y�gkk...V-77—r__9i/Ce------ ----------------------------------------------- Phone--Oe�K6- - a,?ev/ Installation will serve: Residence [4- ;6rpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.l__ Number of bedrooms Number of baths __f__ Lot size ------ -------------- ------ Water Supply: Public systemommunity system ❑ -Private ❑ Depth to Water Table _ _Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ,ll Previous Application Made (If yes,date--------------------j No I] New Construction: Yes El No �HA/VA: Yes [:] No ❑ TYPE OF INSTALLATIONI1'l AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Sic � Distance from nearest well---------------_Distance from foundation-------------------Material------------------------------------------------- No. a compartments--------------------------Size--------------------------------Liquid dept----------------- --------Capacity------------------------ ,i D i e Distance from nearest well-.�---�.�.Distance from oundatio ____ _ __.-_-Distance to nearest lotine Sf.---__-. I III t--r r-- Number of Imes-___�___ _____ ___ ____ Length of each line_ __ Width of trench_.___ _-__.____ i 'I° -----r Type of filter materia Depth of filter mate iaL.-__1_ Total length____________________ _____ _________ { Seepage Pit: Distancle to nearest wefl_�_ �_o-_ ____Distance from fun da tion_____Aa- ---------------- N �__�_.Distance to nearest lot ine_____-_ e ------ Numb t of pits------ ------------Lining material--L2_ -c__'__ ----Size: Diameter__-,5-3_�1----._Depth-- ----------__---- r lit I Cesspool: Distance from nearest well________________Distance from foundation....................Lining material------------------------------------- 04 Size: i ,iameter-------------- ----- -------------_-,De th-------- ----- --------------------------Li Liquid Capacity:... ❑ ;I11 p q -------------gals. Priv Distance from nearest well_------------------------------------------------Distance from nearest building __-______-. ❑ Distance to nearest lot line-- ------------------------------------------ - ----------------------------------------- ------------------------------------------- , r Remodeling and/or repalrlg (describe):---------- - ------------------ r ,I -'----- --- - - ------ - -- ---•-------------------------------- I / --- -- --- - -- ----- ----------------------------------------------- II! --- ---------- -- - - ---------------••--------------------------=------------------ - ---------------------------------Z-1 ----------------------------------------------i------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby cert' that li have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t I s, rules d regulations of the San Joaquin Local Health District. (Signe pp �` } c t------------------------------------(Owner and/or Contractor) By---------------- 1�` -------------------------(Title)--------------- ---------------------------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y- - 1 = - DATE----- REVIEWEDBY--------------------!�---------------- ----------------------------------- --------------------------------------- ----- DATE •---- ----------------------------- --------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------ - DATE------------------------------ --------- Alterations and/or recommendations: ndations•--____--___ i - Q Q ---- ----------------------------------- -------------------------------------------- - - - ------------------ I q ---------------------------------------------i------- -------------------------------------- - --------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY'------- --- - ------- ----,-- I---- _ Date----��/1 --- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street �1 l Stocklon,California Lodi,California Manteca,California Tracy,California i . 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