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FOR OFFICE USE: 3Q 5 -f7—�-------------------- --- v'�061 APPLICATION FOR SANITATION PERMIT Perm! + No. ........................ ------------ (Complete in Duplicate) -------------------------------------_---_....__----_.__. This Permit Expires 1 Year From Date Issued Date Issued 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. , - �. _ _ JOB ADDRESS A OCATIIQN__J____ ________ ____ ` Owner's Name / /_--•- - ----- --- �)zt Phone l`��1 -.-r8 Address � 3 �� rZ` w --•-•------------------••----•-•-----------------------------__-_--•------------------•--••-----_---- Contractor's -------------------------------------- I Name----- l ------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size _________________________________________.____._____---_-__ Water Supply: Public system ❑ Community system ❑ Private 21"bepth to Water Table 74--ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rardpan ❑ Previous Application Made: (If yes,date -------------------) No ❑ New Construction: Yes ®r-'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 9pt•c Tank: Distance from nearest well-----------------Distance from foundation- -----------------Material...._-__--------____._.___.________----.---____. No, of compartments------------ -----------Size-------------- ---------- ---Liquid depth--------------=-----------Capacity------ --------------- Dispoosa Field: Distance from nearest well-62).- Distance from fou dation`_•�d____.._.Dist ante to nearest lot line_`-___-.-_-_-- L�" Number of lines�-___ - g -toe i Len th of each li ------------ e------- �' ._-__1l dth of trench--------- - $l Type of filter material___5�_ _ __Depth of filter material___. y_...._...Total- length- ------------24-_ ----------- .... i Seepage Pit: Distance to nearest well-��-l-_t___Distance m foundation_,l_ 4_�_.Distance to.nearest lot line--_--_ze__.._ [� Number of pits______ ____________Lining material- C/�'___-Size: Diameter-__--//9. ------ Dept h.......r�S---_.______.____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___---___-_- __.__.__________-_- F] Size: Diameter------------------------------------Depth_------- --------------- ------------------ --------Liquid Capacity----- ---------------------gals. 61r Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_ ________.._______.------_..._. ❑ Distance to nearest lot line----------------------�------------------ ------------------------------------------------ lc ----------------------------------------------3 -- -----J- -- ---- •---- - ---- - ---- Remodeling and/or repairing (describe]:_ . ---------- ------------•- t - - ------------- --------------------------------- --------------------------------------------------- ---------------------------------------------------------------------------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tolaws, and rLAes a d regulations of the San Joaquin Local Health District. --- - ---------------- Owner an`d or Contractor) (Signed)---- -------- / ) By:------------------- = == - ------- AV ---------(Ti+le)- - (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be p aced on reverse sidel. c FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--------=--— =f ----------- ---------------------------------- DATE -' , I� �� ` REVIEWED BY----------------------------------------- ----- ------ --------------- ------ DATE-----------=-------------------------------------------------- BUILDINGPERMIT ISSUED-------------- -�--------------------------------- DA•TE---------------------------------,--------------------------- Alterations and/or recommendations:.-__ -- .7_ __�.._�_--------- =1 ------ ------ =-` ~'` `----------------•----�`---------------- --- --------------- F --- -- -. -------- --�� --------- " ------``- ------.,��_ - ----------------------------------------- ------- ---------- ----------------- ------ ------------ --------------- -- --------------------------- ------------------------------------------------------------- FINAL INSPECTION BY:. Cly' - 1 •-� --------- DateY 7-:/------------'------------------------------- AN 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 F.P.CO. "• F