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FOR OFFICE USE: ------- ------------------------------------- ----- 0 APPLICATION FOR SANITATION PERMIT 3. Permit No. -12.�- ------ ----------------------I-- ----------- ------------- ---------------- -- --------------- (Complete in Duplicate) Date Issued k�q- -- - ------------------------------- - --- -------------A 'This Permit Expires 1 Year From Date Issued Application is hereby maclie4o the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made inYcompliance with County Ordinance No. 549. (:�7, � Rp --------- ---------- JOB ADDRESS AND LOCATION. A)�--,:5s--- ®x lam?---------- ---•--- Owner's Name------ ------------j- ----- Phone------------------------ -Address-----------•---------- -------------------------- ------------------------------------- ---------------------------------------------------------------------------------------- Contractor's Name----------- --------- ---- ------------—----------------------------- ----------------- Phone-�� .......... Installation will serve: Residence Dd Apartment House ❑ Commercial 0 Trailer Court 0 Motel 0 Other [I - - ------------------------- Number of living units: _--1--- Number of bedrooms Number of baths Lot ---- --- A0 Water Supply: Public sys�tem Community system ❑ Private Depth to Water Table -lq ft. ,f Z,E] x )( Character-of`soil to'-� depth of 3 feet: Sand 0 Gravel 0 Sandy Loam F] Clay LoajClay 0 Adobe [] Hardpan [I Previous Application Made: (If yes, .... .....I �o X New Construction: Yes 0 No )d FHA/VA: Yes Ej NoX- - — —'- 2 5x--. . I TYPE (5-F*IkStACAJj6NkAND SPECIFICATIONS: I I r.is available wit hin.200 feet.) (No septic tank or cesspool permitted if,public ser-P --------------------Materiai------------------------------------------------- Septic Tank: Distance from nearest well-s,"___---"""".""Distance from foundation - ----- -- --------------Liquid clep�h--------- pacit -----------------Cay----------------------- E] 6g1Sr114 No. of compartments---------_y;; Size--------------- Disposal Field- Distance from nearest well----TO-1—Disfance from foundation------99........Distance to nearest lot line_-- a.... 9A Pel 1 t16 Number of lines------------- -----------Length of each line--------Cas`----------.Width of trench---------- A0 Type of filter material-lo-,86CAC.-Depth of filter material-------I-e-4 Total length------------------- ------- -1 A.,� Seepage Pit: Distance to nearest well--------------*--1---Distance from foundation-------------------.Distance to nearest lot line--------._.------ C� ❑ ine----------------- EI Number of pits----------------"""---Lining! material------- ------------Size: Diameter-------------------_---Depth--------------------------------- Cesspool: Distance from nearest well---------------" Distance from foundation---------------------Lining material-_-----------_--__-.-----------------. Size- aterial--- ----------------------------------- Size- Diameter------ - --- -- - ------- ---- -- ------- ----Depth---- -Al'-A---- - -��: -----------------gals. - ------------Liquid Capacity---------- 0- Privy: Distance from nearest well--------- -------" --" ---. -------------Distance from nearest building.__---------- ----------------------- Distanceto nearest lof;hne----------------------------------- --------I---------------------------------------------------------------------------- -------------------❑ Remodeling and/or repairing (describe):------ --------T2... --------- yS t ----------------------------------------- ------------------------- -------------------------------------------------------------------------------------- ------------------ --------------------------------------------- ------------------------------------------ -------- - ---------------------- -------------------------------------- ------------------------------------ ---------------------------------------------------------I---------------------------------------------------- ---------- ------------------------ -------------------------------------------------------------------------------------------------------------------------- -------------- ------------------ ---------- -- I hereby certify that I 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. (Signed)------ 4-�A,6�11------% 0- �� -1------0------t-------- ---- - --------- --------------------------------(Owner and/or Contractor] i' F ---------- ----------------- --------------- By:----------------- --- - ------- By:------------------PC- ------------- - -----------------(Title);---------- (Plot plan, showing size of lot. location of system in elation to Wells buildings, etc., can be olaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- --------------------- - ----------------------------- --- ------ DA E - ----- --- --------------------------- REVIEWEDBY----- �---------------------------------------------- -- --------------------- ----------------------------- - ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- - - --------- DAT ---------------------- - ---- -------------- Alterationsand/or recommendations:-- -------------------- ------------------------------------------------ ---------------------------------------------------------------------------------------- i A , ------------ ------------------------- ---------------------- ---------- --------------------- - ----- -----------------•----------- ----------------------------------------------------------------------------------- --------------------------------------------- ------------------- ------ -------------------------- ------------------------------------------------- I----------------- ---------------------------------------- -- -- - - -------- ---- 1 D tAE 'T . .. .... ........... ---------------------------- ----- - -------------- -----•------- — --------------------- -- ------------------ -------------------------------------- ------I---------------------------- ------ --------------- --------------- --------------- ......... —------------ - ----- ............ -------------------------- ----------------KS--- ------------------------------------------- FINAL-'INSPECTION-BY.`--- -------------------------------------------- ---------- Date---- .6--------------8 ------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Kaxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F,RCO.