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FOR OFFICE USE: a ' ' ------------------------------- APPLICATION ; �j ;FOR SANITATION PERMIT Permit No. 7_ yQ•x� -------------- ---------------------------------- ._ . .�r� IM-- ---- ------ (Complete in Duplicate) ---------------------__ This Permit Expires 1 Year From Date Issued Date Issued .-- it Application is hereby made to the San Joaquin Local Heal+h District for a permit t construct and install the work herein described. it This application is made in. compliance with County Ordinance No. 549. � JOB ADDRESS AND LOCATION-----P___Y1A0X_I Owner's Name � t�Ll�g� =} ------------------------------------- Phone------------------------------------ Address-------------------------------- W_ )-I--- ?F'� ',`� r` ' --------------------•--- Contractor's Name f.� � I� ------- --------- Phone------------ :--------.-.-- -- 1 Installation will serve: Residence Apartment House La Commercial E:1 Trailer Court [I Motel E] Other ElJ ` Number of living units: __.!.___ Number of bedrooms �._ Number of baths_ j ____ Lot size ___, _ 1- _______________________ Water Supply: Public system ❑ Community system ❑ Privateepth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel!El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 04Harcipan ❑ :Previous Application Made: [If yes,date,-------------------} No J1/New Construction: Yes_❑_No A/VA:zYes ❑.— TYPE OF INSTALLAT64N AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank- Distance from nearest well-________________Distance from foundation------------.------Material-_____._____._..____..._________...______..____- II � (f sNo. of compartments------_---- ------------Size-----------------------. ---Liquid depth---------- ------ --------Caacit iDisposal F' Distance from nearest well------Distance from foundation----/A-1 __._..Distance to nearest lot 1��_4 Number of lines---------- ---- _Length of each line___ __� Width of trench-_ __ _--_____..___.____.___. 7 /Ij!f of filter material-_-_.j.�2 --De th of filter material_._.1- ../.._______Total length_____!---------------------------------- Seepage d ____ i Xl� J � I P :r Seepage P : Distance to nearest well ___P_____Distance from foundation__ _____ __________ .�� Distance to nearest lot lin�_r.________ dumber of pits...../_______________Lining miaterial_ s_G� __.Size: Diarnete"r_.__. _ ..___Depth--- Number �f �( ` Cesspool: Distance from nearest well-______---- from4oundation...................Lining material _ -------.--------------_------ _____. _Liq Capacity Ca acit --------------------------9ls a . ❑ Size: Diameter--------------------- ---- -----------Depth-_._f=--------------- - -------------------- --- S Privy: Distance from nearest well-----------------'l__.---------------------------Distance from nearest building___________ -__-________. ----- - . ❑ Distance to nearest lot line________________EI -------- - �7 Remodeling and/or repairing (describe)---------------e,?P" A ------------------------ --------- ----- - -------------- ----=---------------------------------------------------------11------------------------------------------------------------- ----------------------------------------------------------- I I I hereby certify Aa+I•have prepared this applic`a+ion and that the work will be done in accordance with San Joaquin County ordinances, State pl , and bruleand regulations of the San Joaquin Local Health District. I! (Signed)----------- _ _- ; Iti -- - ---------- - ----------- ------------------------------------------------- - (Owner and/or Contractor),,, h ! BY=--------------------------------- --------`......`' = (Title) t_ (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------------- ii- ` ¢ �-5-------- --V --- DATE------- / --f �---- ---------------- -------- ' II REVIEWED BY---- - -------------------------------------------- !( ---- ------ ------ DATE -- --_I --------------•------------ BUILDING PERMIT ISSUED------------------ ---------------------------- ii - -------- -------• DATE -------------------------------------------- Alterations and/or recommendations-------------------------------- I1 I -------------------------- ------- ----- ------ ---------- ------- -------------- .-A------------------------------------------------------------------------------------ ----------------------------------- ------------------------ jl -------------------------- II------ ---------------------- ------------------------------------------------------ ---- - - -------- -------------------- ;I FINAL INSPECTION Date - r SAN JOAQUIN LOCAL HEALTH DISTRICT f I d t 1601 E.Ha:elfon Ave. 300 West Oak Street� 124 Sycamore Street 205 West 9Th Street ""f� � �t Stockton,California Lodi,California Manteca,CaliforniaTracy,California I I ! ! F.P.CP. Ii