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rUK Ut-rIk.t U51:: ------------------- -- ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. __R --- ------------------------- --------------------------- (Complete in Duplicate) --- -------------- ---- Date Issued -��--- ---- ----------- -- This Permit Expires a Year From Date Issued _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insTII't orFgg rein described This application.isrfnade in.,.compliat ce with County Ordinance No. 549. l�ZCP Z>�:✓•.�.L r.+.1n1 aE.t1_Q ' 641 JOB ADDRESS AND OCATION-/' -----------------------------------ma�yy J --p-- S 3 Owner's Name_______ -3----------- --3----�---�--- L --------------------------- ------------------------------------------------- Address--------------- Phone----..- •------=-•-------- •------------------------Contractor's Name_ ----------------------------•--------------- ------- ------------ - ••------. . _ - ---------------- --- ------------- - ---•------- --------------------------- Phone-- ------ -••---�� a Installation will serve: Residence Apartment House ❑ Commercial Trailer Court r ❑ ❑ Motel ❑ Other ❑ N j Number of living units: .._-_- Number of bedrooms --3- Number of baths _ Lot size ___ Water Supply: Public system ❑ Community system ❑ Private M-1-Sept}1 to Water Table/41 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam E] Clay Loam E] Clay ❑ Adobe [� Hardpan ❑ K Previous Application Made: (Ifyes,date- ---------) No ew Construction: Yes E] No �HA/VA: Yes ElNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or cesspool pe-rmi+ted if public sewer is available within 200 feet.) ank; Distance from nearest welt-----------------Distance from foundation-_-_-__--__----.__.Material___________-_._____ ----------------------------- No. of compartmentsZe----------------�---- -----Liquid dept;---- ----------- ----- Capacify-•----------- Disposal Field: Distance-from nearest well._5_U------Distance from foundation____,9.__ _--Distance to nearest lo+ line_f5�/ 1 Number of lines_ _______._�-- -Length of each line-_.,`G_d_.-._ Width of trench--._ - r _r----------------- Type otr filter material-___. .. l&�ArDepth of filter material--_/1qTota! length -------Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.-.--._-__-- ❑ Number of pits- -------..__Lining material----- -----------------Size: Diameter.--------- -----Depth---- ----------------------- Cesspool: Distance from nearest well__'---------------Distance from foundation.r--------------. .Lining material------------------------------------- ❑ Size:,Diameter --�_ -------------------------------- Depth------- ---- --- Liquid Capacity --------- __ga Priv —�^..•+....��.....,a,�w..�:..-,�-��,�,_. y Distance from nearest well ----_---_-__------------------------------- Distance from nearest building ❑ Distance to nearest lot line-' Remodeling and/or repairing (describe):---------_j_.__-_-- k ---------- --------------•----------- --------------------------------------------- -- - s---•-----------------------------------------------------------------------••----•----•----- ------------------------------------------------------------------------ ---------- ---------------------------------------------------------------, . I l� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �! ! ordinances, St laws, and rules and reg tions of the San J quin Local Health District. —v (Signed)------ --------- - er and Contractor) By--------------------- ------------- - -- ------- - -------- Plot Ian, showing size of lot, location of system in re (Title)--- � m . - P 9 la+ion we Is, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....------- - E / -------------------- ------------------------ --------- ---------- -- ------ J j, REVIEWED BY---- ---------------------------------------- ---- - ------------ --------------- - - ---- --(ham'-----•--- 'ATE------- ---- � -" -_ BUILDING PERMIT ISSUED = =--------------- -- ----- -- - Alterations and/or recommendations:-------------------------+ ' - - �. � _ TE , ----------------------------- ----------- ------------------• ------ --------•--------------------------------------------------•-----• -------•--- ----------------------------- - --- € ------------- ----------------- ---- - ---- - FINAL INSPECTION BY-------------------- ----- - ` �O -------- 6 C—' Date---------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1461 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9tF,Sheet Stockton,California Lodi,California Manteca,California Tracy,California F.P.