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R OFFICE USE: p 71 � -- =APPLICATION FOR SANITATION PERMIT Permit Na. ............ / ----------- ------------------ -------------------------- I (Complefe in Duplicate) Date Issued �- 4 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. Thisy aff�pplicatioon�/is made in compliance with County Ordinance No. 549. 10(9— 2/ ----'�-- 1� �� --- �� "aIl �.� � JOB ADDRESS AND LOCATION Owner's Name----------- -----•-------- -- ----------- -------------- Phone---. Address----------------------_ ----------------120X----•--'.1. pp--6•---•----- -------------------------------•----•---•-------------•----------•---- Contractor's Name--- --------------- - am ------- �! -------------------------------------------------- Installation ----------------------------- -- --------- --•---Installation y will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,4� ,a�. !' ------------ Number of living units: __.� Number of bedrooms _--.I-Number of baths __I---- Lot size _______ _______ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.---.------ No1-11 ew Construction: Yes El No �HA/VA: Yes E] No ❑-- TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within ' feet.) � I f X45.---.Material-- �.a+'.5 --------- ' Septic Tank: Distance from nearest well____--Distance from foundation__. ____ �� &,k-& k.4'?... .Liquid depth-----%5"Y-----------Capacity--ef-__------------ No. of compartments---__ ..---_7:-----___Size__ __ - Disposal Field: Distance from nearest well_.,.-�Distance from foundation-_ �---------Distance to nearest lot line.-! rn ' Number of lines-_______-�----- --- -----------Length of each line----1�--- ----------Width of trench_____ __ _``._---�--- (� De th of filter material__ ''� -_Total length--_--- '----- -- ----- Type o£ filter material_._5��4. p , Seepage it: Distance to nearest well--/ Distance fr m foundation____ '�.___._.Distance to nearest lot line_ Number of pits---..__ ---- ___.__.Lining material_ O -Size: Diam __. eter .___ _ `! . Depth - ------------ S Cesspool: Distance from nearest well----=------------Distance from foundafion--------------------Lining material--._-------__----_.-----__-------.__. N ❑ Size: Diameter------ --------------------- --------Depth---------------------------------------------------Liquid Capacity-- ------------------------gals. �. ....Distance from nearest building------------------------------------------ Privy: Distance from nearest well......... , ❑ Distance to nearest lot line----------------- ---------------- ---------------------------------- ----------- ------------------------------------------- - . f C '.�'lr "� ----------------------- Remodeling and/or repairing {describe}:_._____.. - P. 7 ---- `I ---------------------------------------------------- I ------------------------------------------ ------..._----------------' ----- --------------- F ---------------------------------------------- ------------- - - ----------- ------------- ------------ ------------------------------ -------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County regulations of the San Joaquin Local Health District. ordinances, State laws, and rWAp } ler = or Confracfios (signed) �.�� /_�._ l ------------------------ By•-------------- -- ---- --- -------------------------(Title)--- -------- (Plot plan, showing size o`i__17. ocatrion of syste it relation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APP'LIC S --- ---'- '=.::�z -- --------- ------ --------- ---- ----�-�--�'---------------- i ATfQN ACCEPTED BY -- ------�----- --- - --- - �:T:�-'--:.:-:--- '- --- REVIEWED BY DATE- ---------- -------------'------------------------------ -'-------' -------=---- PERMIT ISSUED---------------------------------------------------------------------------------- ----: ------ DANE--------------- BUILDING -�------- ---------------------------- -- R s - -_— { Alterations-and/or recommon dations:----_ I .. G--tom'----'�`=� = �`.`. '`< c _�"` �` L' - ----(--------- !- ----------- ----------------------------- ------- f �� ----------- ` > r�- +�~ ' k _SII —t Vii- i��-----------��f - it'll ' f ---------------------------r--------------------------------------------------- �- --------------------- ------ - FINAL INSPECTION BY:_ Date--------- - --------------------------- ---------------- i, SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracyr California � Stockton,California a r F.P.CC.