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'. FOR OFf ICE USS y ---------------- ------------------- - - -- -------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. f?� --. -------------------------- ---=------- ------------- [Complete in Duplicate] / Date Issued -------------------- This Permit Expires 1 Year From Date Issued _ll__cr -rds-cS Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication is made in compli nce with County Ordinance No. 549. E 2eS-0717- ((, ErALrj �- } JOB ADDRESS AND L CAT C'r r _ Q -r Al- -0------------------------- r Owner's Name-------------N---------F—JELK.EM_A----------------------------------------------------------------------------------- Phone------------------------------------ Address--------------------R-T.E......I--------------Box-------/2-5- -©•-•----•-- Contractor's Name----C1413&}_L�------------------------------ •----------------------- ---------------------------------------------•---. Phone----------------------------------- Installation will serve: Residence Pa'�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1.-_ Number of bedrooms___ Number of baths _. __ Lot size ___144 �-___ _ -----------•------- Water Supply: Public system ❑ Community system [-] Private (Depth to Wafer TableZ, _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ! Previous Application Made: (If yes,date--------:....._r....) No 2RO"-New Construction: Yes ❑ No ®"IFHA/VA: Yes ❑ No fj— T TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank:orticesspo_Lpe�rm fffeedd ifrpublic sewer,is available within 200 feet.) _yam Septic Tank: Distance from nearest well____570-___Distan e from foundation___ 20-------.Material-- CQR. T T No. of compartments.-.-,___ Q X_ �� Size - X� Liquid depth__.Z'e'-.7 ------Capacity_1Z_0----- Disposal Field: Distance from nearest well.- .....Distance from foundation___.___ �0--_.,-._-Distance to nearest lot line---5_.-___---- N ___ [t Number of lines_________ ___ Length of each line_____ __/_�___r_ ___ ` Width of trench-----, 6---_--_-- Type of filter mate ria L_�Q_G_K__-Dept h of filter mate r,al_____�_�______....Total length-_-__-_.______-�.�.0_______._____. Q, Seepage Pit: Distance to nearest welf------------- ------Distance from foundation-------------------.Distance to nearest lot line_-____.______.._ ❑ Number of pits-------'--------------Lining material----------------------.Size: Diameter---------------- Depth----------------.---------------- Cess ool: Distance from nearest well_________________Distance from foundation-_-__:_ P ----...Lining material------------------------------ ------ 0 Size: Diameter----- ---------- --------------------Depth--r--- ---------------------------- - -------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well----------------------------------------------,-._Distance from nearest building-____-_______________-_---_----._------._. ❑ Distance to nearest lot line------- ------------------------------------------------------------ -------------------------------------------- ------------------------- Remodelinand/or re a-irin describe]:------- ----------------------- ------------------•------------------------------------------- ------------------------------------------------------- -----------------------------------------------------------P4r_-,N.F___tA(1,A(6-------F_K USY h�----- fV:5 ------------------------------------------------------------ ------------------------------ --------------------------------•--------------------------------- ----------------------------------- - - -- ------------------------------------------------------------------------------------------.--------------------------------------------------------------------------------------------------------------- ---- ------ - I hereby certify°that I have prepared ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd reZ ' s of the San Joaquin Local Health District. ;�oi ' {Si ned 9 )----- --- ",-v:-'--- --- ----------- - - ---------------------------------=--------------------(Owner and/or Contractor) _ By:------------------•----------------------------- --------------------------------------------------. ---_-- --(Ti+le)--- ---- --- T (Piot plan, showing size of lot;location of system in relation to wells;butldtngs, etc�cari"be placetf-dn'reves FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 5 REVIEWEDBY-------------------------------------------- ---------------------------------------------------------------------- -------- DATE BUILDINGPERMIT ISSUED------------------•--------------------•---------------------------------------------------- ------ DATE--------------------------- -- Altera#ions and/or recommendations:--.___-.___._- ------------ --------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ----=-------------------------------------------------- --------------------------------- ---- ----------- - ------ - ----------------- --- ------ -- - ----- ------- -----------I----------------------------------- ---•------------- -------------------------- FINAL --- --------------------FINAL INSPECTION - = .-. Date---------- 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 1