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' -------"I !-"( _�_��- APPLICATION FOR SANITATION PERMIT Permit No. .... .............. ------------------------ (Complete n Duplicate) - This Permit Ex fires 1 Year Issued;• From Date Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LOCATION Owner's ---------------- Name.__---•-- -----•---- ------,ec-�--_�'/r�._�J,�--- "�..�� _ ------------ - ------------�--�n - a.C- --------. Phone--i...�1�.� Address - � --- � --------------------------------------f --------------------------------•------ Contractor's Name---------------- � ----------------------------- - ----------------------y ------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other' [] ° Number of living units: _._/' Number of bedrooms --J-- Number of baths __/--" Lot size ........ ___ Water Supply: Publicsystem ❑ Community system ❑ Private 0-15epfih to Wafer Table -------- ft, Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam El Clay Loam Clay ❑ Adobe El Hardpan [] f Previous Application M:ade,de: Ilf yes,date____________________) No 9-"'New Construction: Yes &VNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feet.) Septic Tank: Distance from nearest weliZll "-- !2 Distance from foundation--- [ No. of compartments_----. _ Size- ------- ---- f?'>r'- 'A''1G}---.Liquid depth"-__9�' �� ----- -- Capacity_f "" ssF� Disposal Field: Distance from nearest well_"�1Of "--.Distance to nearest lot line. _ Number of lines--------------- (' ------------Length of each line------ ""-- Width of trench.-__- �T I' Type of fitter material - p it �_-_De th of filter material___" -----------Total length____:. --et---------- S� 6 Seepage Pit: Distance to nearest welf..,�41?........Distance fr m'foundafion-- W ` ________..Distance to nearest lot line_-r -- Number of pits_.__----Vl----_--Lining maferial__�et' e---Size: Cesspool: Distance from nearest well-----------------Distance from foundation---------------- ` . -- _...Lining material----- -------- -------- ---------- x ❑ Size: Diameter------•-------------------- ---------Depth__.:----------- ------------------------------ 7 # Liquid CapacitY -----------------------gals. Privy: Distance from nearest well----------------------------- ------- -- Distance from nearest building------------------------------------------ Distancefo r ❑ to nearest:lot line.......- ----- -------- --- ________ _____ Remodelin9 and or re�airin describe � ' . �- / p g : { } ��t_ _c _ ----•--------------------- --------- - ---- ----------------------------------- -------------- -------------------------------------------------------------- ---------- ---------------------•----------------------------------------------------- ------------------------------ -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Count ordinances, State lawd-r-u s and`regulations of the San Joaquin Local Health District. q y � (Signed) ------------------ ---/ . } '�--�_ E J I .k> -- ---------------------------------------------- - {O era or Contractor ------------------- (Plot plan, showing size of lot, location of syst0n in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__._. i ------------ -- DATE-_-----r REVIEWED BY -' ------------------------------------ - / - DATE- ------ BUILDING PERMIT ISSUED. ------- --------------------------------------------- ------- - _ �1-� D Altera#ions aror recommendaiiorrs.__!_. r� `1 a i� ATE 3- ----------- --- --- ------- /1 ��J 1 ��--_ `=6 - `---:-r=�'-�'�.(�.,------ •;�7'"r� -------------------- • C C , - ------------ ---------- -------- FINAL INSPECTION ,fir / Date--- SA JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E.Hazelton Ave,- 300 West Oak Street , 124 Sycamore street Stockton,California Lodi,California 205 West 9th Street _Manteca, California Tracy,California