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Fq OFFICE USE: :3 0 ------__......... -------- APPLICATION FOR SANITATION PERMIT Permit No- ----------------------- ................... f---------- 1 ------------- ------- ---- (Complete-in.Doricafel Date Issued ................................... This Permit Expires I Year From Date Issued install the work herein d�wlbecl. Application is herebymade �i*san Joaquin Local Health District for a permit to construct and le. This a Wl' * ' 10 X� d i I n ith County Ordinance No. 549. JOeADDRESS A >ILO ATI Owner's Name... .............................................. . ......... ............ Phone...... ................. -----_----_- ............................_...... ............ Address_.................... v Phone................................... Contractor's Name_. .............................................................. Installation will serve:ill,Residence E] Apartment House [I Commercial E] lTraiier Court 6a-<otel C] Other,[I Number of liviAg units-.-/-tNumber.of-bedrooms ..../_ Number of h Lot size .................... V Water Supply: Public system Ej Community system El Private �Zeptth to Water Table ft. Vj,' ❑ Character of soil to a ep+h of 3 feet: Sand [] Gravel C3 Sandy Loam Clay Loam F❑] Clay[] Adobe F Hardpan _ - Previous Application Made: (if ye's,date.............. No L�_�Iew Construction: Yes [] No D� �A/VAYes El No TYPE,OF INSTALLA :ta ri3ON AND SPECIFICATIONS: (No septic or cesspool•permitted if public sewer is available within 200 fet-) •_ D s. ........!�5..........�t ..... .. ...... i ----------------�21 Septic T� i'tance-frcm,nea-rest-wel]7�-/-e _.-Distance from fouriclation.-Ze M 7 No. of compar.,�m _/��........Cap ----------- enfs....zi;?�--------- Liquid dep�th.:. C to nearest lot lin .Y_ Disposal F' Distance trom'nearest well-/ "O._Distance from fou'nd6tion.._,/22_.....Distance e ____ -4iir-cf--linp ----0......Width of french.-c;?. ..................... Numb s... ---------------Length of each Iine_Z9e_,..4: Type of Filter mate ria I_//?�..........Depth of filter material........ lengkh.....k..Ce ................. to nearest well..._.................Distance from foundaiion..................Distance to nearest lot line.....__......_... Seepage Pit:� Di'sfance of pits............ ..Lining material.......................Size: Diameter__-...................Depth_..._..............._............ lint Cesspool; Distance from nearest well.................Distance from foundation....................Lining material_...._..._..._..............._........ ....................... ❑ S110:' Diameter------------------------- ----------.Depth-----------.........................................Liquid Capacity.---- -gals. ah Privy: Distance from nearest well----------------........................... stance from nearest building-:............._......_._................. ❑ Distance to nearest lot lire............................................................................................................................................. Remodeling and/or pairing �deslribe):-------- ... ...✓. -1............. ....................2..................... ----------------------- .............................................. -- ---------------------------- ----------------- ..................... . ......�F�....................... ------ ................................................... .............. .. ....� ---------................................................... .............. .............................................. ........------......................................... ................................................... ................................. an Joaquin County I hereby certify that ve prepare t plication and that the work will be done in accordance with S ordinances, State laws, d les and regi. io of the San Joaquin Local Health District. . .............. (Owner and/or Contractor) ---- ......... ------ (Signed)..................... ......... .. .... ...........(lite. ------ ....... ------------------------------ BY:........................... .. .... .. .... ..... L (Plot plan, showing siz'e o+,,location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------------:-------------------------- DATE... --------- .......... REVIEWEDBY............ ................... ......................................................................................... DATE--------------------------------•--•----------------------. BUILDING ATE------------------------------------------------------------ BUILDINGPERMIT IS§UED....------ ------------------------------- -------.............._.................... DATE......................... .............................. Alterations and/or rec"Ornmendatior"Is:....................................................................................................................................................--------- ......................................................................................................................... ..................................... ...................A...................................... 41 " ***........... ....................................................................................................................................... ........................... .................... --------- .... ...................... -•--•------•-•-•---•••-•........................ ........................ ...................................... .............. ............ -------------- ---------................................................................. � =7�................. ........ ................................................ -xz�......... ....................................... FINAL INSPECTION BY........ . Date ------------ ............. ......... ................. SAN JOA9UIN LOCAL HEALTH DISTRICT 1601 E.Hotettaa Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1) Stockton,California Lodi,California Manteca,California Tracy,California