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FOR OFFICE USE: II APPLICATION FOR SANITATION PERMIT Permit No...o2.cz.l� ......... ............. ....... _... .. (Cornplete•in Duplicate) S^� Date Issued ill,.... This Permit Expires 1 Year From Date Issued �o.'�.....% Application is hereby made.Jto the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCTION!` `....0••.._�eae�?."� •`• ��" ," Q i Owner's Name .... ........ Phone .................................... L Addres-s......... .!i..--�%.-:i�-•• `r+" e-....... est ............. si.... ............. ................. ... . ........... I Contractor's Name ............. i +� .�_ ........ Phone .............. . ................. -nee . _ Installation will serve: Resilience ®�Apartmen� House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units:..!/ . Number of bedrooms ;,3. Number obaths. Z... Lot size-.�-'�-�'-v��.�--�........•.......... t Water Supply: Public system E]Community Sys m C] Private epth to Water Table ...._.. ft ' t Character of soil to a depth of 3 feet- Sand [Er Gravel ❑ S-andy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ t Previous Application Made (If yes, dote_ ....... ) No ❑ New Construction:," Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION IAND SPECIFICATIONS; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance " from nearest yell........... ...Distance from foundation ....... ............ Material ................................ .......... ..... ❑ No. of 'compartments.......... ........... Size ............. :.....:............ Liquid dep, h .......... ........ Capacity ....................... Dispos�,,ld_- DistanceIl from nearest well..✓�6.�......_ Distance from foundation* .........Distance to nearest lot line ................. Number of lines ............ Length of each line..Width of trench.......................... Type of filtermaterial...�r.R.:.....Depth-of filter mate-ial...../..�1.`..` ......Total length...... ............................ U Seepage Pit: Distanc6 to nearest well ......................Distance from foundation................... Disiance to nearest lot line ................. �f ElNvmbe.r of pts..................... Lining material................... Size: Diameter ....................... Depth..................... ...... Cesspool: Distance from nearest well ................ Distance from foundation................ Lining material............ ....................... ( ❑ Size: Diameter. . .................... .....Depth......... ............................:..Liquid 'Capacity................ ......... gals. Privy: Distance from nea,est well................:............:..............Distance from nearest buildin.g.................. ...... . ........... e 11 ❑ Distance to nearest lot line ........... :.... . .................._........ ....................................................... ....._............. .... Remodeling and/or repair !I (describel:..............�. ~. .................... .. ..... ... _... I .......... .. ............... .... I..................... ............ ....................... ........................... _..........•............................................................. :.................... ............ I hereby certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws d rules and regulations of the San Joaquin Local Health District, (Signed)............. ..................... :.. ........... :,........... ........ ................ :nd/or Contractor) By:............. �... .... ............. ............ .... ........ .................... ........:.................... _.._... .... (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). FOR QEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ........ ............................ DATE_/. : 4.,7.................... REVIEWEDBY......................................._ .............................. ... ........................................ DATE.... ................................................. BUILDING PERMIT ISSUED .............................. ................. .............. ..... .. .................. DATE......................... ' ........... .............. Alterations and/or recommendations:........ ..................................................................... ......... ........................... ._........... ............... .... . li .. a( l(.. .................................................................................................................................................. ....... ...:... ..................... .... ......................... ..........1).................................................... ............ ................................................................. -21 FINAL INSPECTION BY:f�/r�t.G;l. ............... Datev...................... IISAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hazelton Ave. 300 West Ouk Street 124 Sycamore Street 205 West 9th Street �) Sloclstan, California Lodi. California Manteca, California Tracy, California E.H. 9 2M 1.67 VongvorJ Press t