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.�� v, vl%,c uJt: s 'G ------------- .-� _ ------ ----- --------------------------- ----- --------- APPLICATION FOR SANITATION 'PERMIT Permit No. ------------------------------------------- -� (Complete in Duplicate) -=- -- --- This Permit Ex ire's i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health Districtfora permit to construct and install the work herein described. This application is made in compliance with County Ordinance-Noo. 549. JOB ADDRESS AND L C TION___--___1I--3 3 /,,. --------• --- ems`��f Q Owner's Name_ - - - ----------------------------•-----------•----------- Address ------------------- ------ ----- Phone_ _=✓ ? ---------------- -- - --- --- - --- 10, Contractor's Name_______ !,ii'� ---------------- Phone--Installation will serve: +Rdence � p tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ _ N ber of bedrooms _:: - Number of baths _4 Lot size7 -----� � � Wafer Supply: Public system Corrrmunit system Y Y ❑ Private ❑ Depth to Wafter Table-" {}, : Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E3 Adobe Previous Application Made: (If yes,dgte.__._--------------) No [ New ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [ New Construction: Yes El No [5 rHq�VA: Yes El No ❑ W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) : \may . Septic Tank: Distance from nearest well-._._'.________ Distance from foundation-------------------.Material ---_--__-.-_. _ ❑ No. of compartments----------- ------.Size-------------- -- -----------Liquid depth --- -------------Capacity-- ------------ Disposal Field:. Distance from nearest well Qi Distance from foundation__-,0- ------Distance to nearest lot line___S__-�-•• ! ✓ .. --- Number of lines-----/-,---__-_.- Length of each line_.-�Q____-__s----------N/idfih of trench.__-��----__- - - -- Type of filter material_ f. . - < Depth of filter material ---_____--._ -------- Seepage Pit: Distance to nearest well.___._-___-___ ---- otal length___.--_------_ /s - ------------ ._-___Distance from foundation--------------------Distance to nearest lot fine-------___.___ _ Number of pits------------------ -Lining material-------------------_--Size: Diameter_------------- Cess oof: --- -----Dept h--------------- ------- -- P Distance from nearest well--------------- Distance from foundation_---_____----_----.Lining material------Size: Diameter-------------- ----------Depth------------- ------------------------ ----------- ---------Liquid Capacity- .---------------- PrivY=. Distance from nearest v✓ell_ __________ _ -----�--gals, -------------------Distance from nearest building__.-_--.-------__ ❑ Distance to nearest lot line--- --------------------------- --------- -------------.-___-- '. _________________________ 4 emodeling and/or repairing (describe):------------------------------------ ------------------------- ------------------------------ - --------------------- I hereby certify;that'l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and egulafions of the n Joaquin Local Health District. 1 f (Signed)------ By.- t t ------ Owner.and/or Contractor --•--- -----------------•------- ----------------------- ---------- -- Title __. _ (Plot plan, showing size of lot, location of system in relation fo ls, buildings, etc., can be aced on reverse side). ----------------- ' DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-__-- ----------------------------------------------- DATE_-_= 'y- rte' REVIEWED BY --------------- BUILDING PERMIT ISSUED - ------ DATE- -- Alterations and/or recommendations: - DATE. ---------------------------- ----------- --------T -------------------- ---------------- --------I----------- FINAL INSPECTION BY:_.__-..._ _ ----------- Date--.----- -- G - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California Lodi, California 205 West 9th Street Manteca,California Tracy,California