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APPLICATION FOR SANITATION PERMIT Permit No. Com lete in Du Y ylP ( Duplicate)P P Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to constm and install the work herein describe d. This application is made in compliance with County Ordinance No. 549. �(�� \1 .......... JOB ADDRESS ANDILOCATION c ��.12,0.....A......... rSe°' "'1 _fC -------------------- P c y -------- 5.,; ----. hone Owner's Name----- -"----�= _25= -- (�1�-LI� G1.F_.f. -:--- y Address. ��tf.='max r._:. i'�y..eSi1CC1./1� -•--•----------•- �- = -• _ Contractor's Name ------ Phone-246.��. - �'-`- lnstallation will serve: `Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ t Lot size -- f�� Q------------------------ Number of living units: Number of bedrooms -------- Number of baths __ Water Supply: Public(system Community system F-1Private ❑ Depth to Water Tablepft. Character of soil to Wdepth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No INew Construction: Yes ❑ No FHA/VA: Yes F] No�'` TYPE OF INSTALLATION AND SPECIFICATIONS:!. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic�ank' Distance from nearest well_________________Distance from foundation.__.------------__Material....._..:......_._.._._.....____:......---...--• f y `' Li uid de th-------------- - --------Ca acit No. of compartments--------------------------Size---•-•--------•---- --------- q A - • P Y-------------- .. ispo .i !d Distance from nearest eIL. !PVC-Distance from foundation._./0?_�_..__.Distance to nearest lot fin/�.. ____..__. ► ��- Number of lines...............:. ____-.---Length of each tine___. .-____-- ...___.._.Width of french-----Z. --_._...-_-.__..-.-- �i ..Total length __� s Type of filter material_.__:_ _C�i ..---Depth of filter matenal--.__ t :.__..._. g '� 04 Seepage Pit: Distance to nearest well____/� .�l--_Distarice from foundation_.__I�--*---**---.Distance to nearest lot line j,_-��---------- Number of pits------ J• -.. Lininglmaterial__-:-- � _ Size: Diamet er__,_33_------._ Depth_.r7.f------------------ Cesspool: Distance from'nearest well---..............Distance from foundation-------------------.Lining material-................................ ..._ ❑ Size: Diameter-----------•------------. - Depth --i--:_Liquid Capacity......----•--•••••......•---gals Priv Distance frominearest we11.............:..........•------------------=-- Distance from nearest building.__ -._____ Y . I . _ — .. ❑ Distance to nearest lot line:_____._. --------•----------•-----------------••-----•---- -------- -- , .� Remodeling and/or repairing (describe):_..-- _ ------------ _-- ---- I............... •----- g •- _ t ----------- �x =, v ----""-"--- ---" - - ........--••-•-•"-.• ....-- ••••" ....... """ q I her eby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Count,, ordinances, State laws, an rules and regulation of the San Joaquin Local Health District. ---•---- -(Ow era - - n 0d/or Contractoi -- '--"--- f (Signed) ` - (Title)-----� fl ✓.. ?� ...,-.1__...--.. BY:-------•-_--.-s-irz" -o.f lot,plari, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE------ .±G' APPLICATION ACCEPTED BY-------- - ---------•-----------•- REVIEWED BY... .......................... DATE----------------------------------------------------------- DATE..... .................................................... BUILDING -----------•- ----••.---------•-•-----•-----•----•- BUILDINGPERMIT ISSUED----_-----•----...---•----------•----•---•--•----•--------•---------- •---•-.....----•--•-..--•-• Alterations and/or recommendations:....................••---...---•-••---•-----....•--------------------•---•-._.------- ---------- ------------ ----------"...... S - .14 ( __._ ....... ............................. ________________________ Date.- - "j� -..� - •-•---•--•---•-=------•---.. ...............•- FINAL INSPECTION-BY::-:_.s-_7:'- _ :------ SAN JOAQUIN LOCAL HEALTH DISTRICT y 132 sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California Y�