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FOR OFFICE USE: ;e /0?,— r__:_._----Ate------ ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. � ----------- ------------- --------- ---- Duplicate ------- This Permit Expires 1 Year From Date Issued Date Issued __/41 Application is hereby-made to 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. I JOB ADDRESS AND LOCATIO1-------------1__. S------- Gq 13 I-.D i T�_UP Owner's Name �-}I LLLI ,S a/1(.`�Ti jl C'>rlC CQ--`----- -------------- Phone----------------------------------- Address--------------••-Q._3 2--..-----Pa_1 N1=llolz�--------- ,---- ..----------------- •- -- Contractor's Name___,1_4 RF - -FU S-_aR---•---------- ••---------- ------- - ---------=--- •------ Phone------ --------.------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ } Number of living units: __t____ Number of bedrooms -3--- Number of bathsLot size -------------------------- Water Supply: Public system 9�_tommunity system ❑ Private ❑ Depth to Wafer Table/.3_ ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mader (If yes,date--.._ ----------- ) No New Construction: Yes [g--Iqo` ❑ FHA/VA: Yes R--�No ❑'� TYPE OF INSTALLATION_AND SPECIFICATIONS: (No septic=tank or cesspool�pemitted if public sewer is available wwthin 200 feet.) Septic Tank: Distance from nearest well---- _:_ Distance from foundation._./A0- ._.Materi I --------_--_-- _ Ca ac o�--No. of compartments- - -2--------- Size-_/ X.�D-X _ - Liquid de th____ ity--- Disposal . Field: Distance from nearest well_'C.-AV_ from foundation to nearest lot �r Number of lines -----------12 Length of each line---'q Width of trench------------- .. t Type of:filter material__9 .4 / ------_Depth of filter mater al....L9_--- ------Total length----------------- - - ------ Dit �----- Seepage Pit: sance to nearest well----_--__. Distance��from foundation_ i � -. ____--, __________________ Distance to nearest lot line_____.__.-_._--._ ElNumber of pits.------------..._--Lining material------- -------- Size: Diameter-----------------------Depth_._.----------------------------- Cesspool: Distance from nearest well ________________Distance from foundation....------------- ..Lining material------------------------------------- ❑ Size: Diameter- -- --------- ----- - -----.Depth------ --------- Liquid Capacity gals. ! Privy: Distance from nearest well---------------------------------- --------------Distance from nearest building-------------------------------.--_--_._. [� Distance to nearest lot line -------- ----------------------------------------A--------------------------------------------- -------------------------------------- Remodelingand/or repairing (describe}---------- -------------- ------------- ---------------.---•------------------•-------------------•------------------------------------------------------ -----------------------------------------------------------------------------------------•------------------------------------------------------------------------'----------------------- ------------------------------------------------•--•---------------------------------------------------------------------------------------------------- - ---- ! hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,"and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed) -- ----------- -- --------- ( / B - �a� { itle)-- �----------- --- ---- ----- - Y� ----- -=�'- - - T C (Plot plan, showing ze of Io , location of system in relation to wells, buildings, etc., can be placed on reverse side). r . r FOR DEPARTMENT USE ONLY p Y APPLICATION ACCEPTED BY--------T1-J=�tD-------------------------------------------------------------------- DATE-- --'7--7`4,7------------------------------ REVIEWEDBY----- ----------------------------------------------------------_------------ ------- ------ ------------------------------ DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED---------- --------------- - - -- - -------------------------------- DATE-------:------------------ . . Alterationsand/or recommendations------- --- --- ----------------------- :------------------------------------------------- ------------•------- ------------•-------------•------------ z �, 7•� LSH e!� ,G/tLl Qr /� c -----------------------•------------------------------------ /- ----------•---------------- -- -- -- -------------- ---- --- ---------- ------------------------------ ------- ------- --- ----------------- ------- ----------------- ---------- / ------------ -- ------- . ----. - - - --- - ------ -- ---------------------------------------- ---------- I FINAL INSPE N BY:.. � --- ------ ------------- Date w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street- . 124 Sycamore Street 205 West 9th Street Stockton,California' Lodi, California .. Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press t - —