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FOR OFFICE USE: lK`pa____ . __ _ " APPLICATION FOR SANITATION PERMIT Permit No. __. _....k ..1 ---- --------------- ------------- - ----- (Complete in Duplicate) _ __---..__.._----_-__.-___.._._ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei des Irbed. This application Is made In compliance with County Ordinance No. 549. ` ! A ,►JOB ADDRESS AND LOCATi N- -- - -- -- _ .: , ' , ., ,d Owner's Name �f -= --- ----------- Phone-•------------------_2! . Addr�ssG __ �� - -•----------- ------------------------- Contractor's Name-------------��40..... �Q/ -------------------------------•- ------------------------------------------. Phone I Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ® 1117 Number of living units: __"^'p-- Number of bedrooms Number of baths --A-- Lot size -----------------------c----------- 10 Water Supply: Public system ❑ Community system 9T"Private ❑ Depth to Water Table _46jO ft. I� �j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam-0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------- No WR' New Construction: Yes W No ❑ FHA/VA: Yes ❑ �FNo [jis I , 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__..1Rs -_-__.Material_ . ' _-_-__-_.'y___._.____. ' No. of compartments_.. -----------------size�4 _�--9�-----Liquid depth..........- -------Capacity_-- -��-_--_-• Disposal Field: Distance from nearest well---.- ----"Distance from foundation----_,i�___..Distance to nearest lot line___ -------- Disposal i T e of filter material._` _A� 6epth of filter materia��sd----- Total length____ � .________I� Nupmber of lines---------- Length of each line__---_ Width of trench.._,r _______________�""----------- ------------------------ Type "" /' ® I __Distan to nearest lot line-.41----------- Number / Seepage Pit: Distance to nearest well___._�.-^ ____._Distance fr m fo ndation____��____ ��, t --•-------- Number of pits.-_-----/-----------Lining material---L§�---Size: Diameter._._,-------------Depth__ 4# Cesspool: Distance from nearest well----------------"Distance from foundation-_---------------- Lining material___.______._--____.___��_______._._.. ❑ Size: Diameter--------------------------------- -------- ----Depth-------- ------------------------------------------Liquid CapacitY -------------------'- ----gals r. Privy: Distance from nearest well--------------- -----------------.-----____"Distance from nearest building----------------------------I_-______---. a ❑ Distance to nearest lot line---------------,-------- --------- ----------------------------- Remodeling and/or repairing (describe)--------------_-- --" - "' _,140 ' r _. - ---------- - ------ ---------------------------------------------------•---------------------------------------------- - --- - ui I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, ' (Signed)---------------------------� ------� �'+("�+/ ---------------------- -- /or Contractor) - - -------------------------- f system in relay "t "" � ----""-"--(Title)._. ------------- --- ---------- (Plot plan, showing size of to+, location o y o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I� I / l APPLICATION ACCEPTED BY.. --------------------------------------------------------I DATE-------7-- Ip -------------------------- REVIEWED BY----------------------------------- DATE I- BUILDING PERMIT ISSUED----------------------------------- - ---------------------------- ------ � D _ -------------- I� •� ` !----- - - --�---�--°- -`- --------- --- Alterations and/or recommendations:_____.-___ - d �- --I --- ---------------- ---- -------------------- --- -------------- ------------------- z = E ----- --- -------------------------- --- '"-------------- ------------------------=--------------------------- k FINAL INSPECTION BY:.. ��P/i-{? Date__.... . 11 ' .' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street' Stockton,California Lodi,California Manteca,California Tracy,California ' F.P.C O. - I�