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FOR OFFICE USE: - - �2 If 7_5 --------------------------------------------------------- APPLICATION FOR .SANITATION PERMIT Permit No. .. ................. . (Completiiri *icate) Date Issued- --------------- ------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION------------Clones----------llc rI--------------------------------------- - ---------•---------------------------------------------------- Owner's Name-__,A4a P_ -_.ra5Te_12.---------- L ------------- ------------------- ------------ -------------- Phone__S'3-7_.5wOL(o---- Address--------------------------------fQf3f0 �b � ----------- -------------=------------....-------------------------------------------------- ---------------- Contractor's Name---------------------�-^-61wf-----------------------------------------------------------------------------------=-- ----------------- Phone---------------------------------- Installation will serve: Residence {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms -3- - Number of baths j__-_ Lot size --------- -- -- ` ------------------- Water Supply: Public system ❑ Community system ❑ Private C&--Depth to Water Table __k__ ft. Character of soil to a depth of 3 feet: Sand'E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ®/Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------- --) No [tom New Construction: Yes ❑ No [:3, FHA/VA: Yes ❑ No ❑ XSI TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well----90_-----Distance from foundation__.-tr_.____.Mat is--__ No. of compartments------------X----------Size--------------------------- ---Liquid depth l��4 ------------Capacity..-- _. Disposal Field: Distance from nearest well---7:.0-------Distance from foundation-----J_;�r----Distance to nearest lot line-_p�?______ G �/ Number of lines--------------- Length of each line----------- -_y --.Width of trench-------- --- -------------_----- ' ES Type of filter material___?_. ...._Depth of filter material______6 -______.-Total length------------ ----------------- Seepage Pit: Distance to nearest well----------------._.---Distance from foundation------------------- Distance to nearest lot line_____""-_-.____- ❑ Number of pits------------------ ---Lining material-----------------------Size: Diameter----------------------Depth---------- --------------------- Cesspool: Distance from nearest well___________ _ _Distance from foundation _._ Lining material ___._ _____..___ _______ ❑ Size: Diameter-�::�.� - -- ;:�___ _---_Depth- - ;L-iquid'C-9pacitY __-- -----— --gales - ,..., Priv Distance from nearest well--------------------------------------------- --Distance from nearest building----------------------------------------- Y ❑ Distance to nearest lot line----- ------- ---- ---------------------------------"------------------- -------- Remodelin and/or repairing describe _------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------- ------------------------------------------------------------------------ --- 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. -- ; (Owner a nd/or Contractor) (Signed)--P-------- ----9 - - - ---- ---- :7.' -------- ------ - ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEP TMENT USE ONLY c� � APPLICATION ACCEPTED BY - --- DATE____ ` -7 ---- - REVIEWED BY. --------------- DATE_----------------------------------------------------------- ---------------- -------------- ---------------------------- 1 BUILDING PERMIT ISSUED-------------------------------- ----- --- - ----- - -- - QATE - E Alterations and/or-recommendations.--- ------------------------_-- -_-- � -/- '�'^'Q Z - -e- ' ------------------------------------------------------------------------------------------ ------ ------------------------------•--------- --- -------- ( --------------------- ------------------ - -------------------------------- ' FINAL INSPECTION B ----- - --- --------- �� Date--- ----s�:'_�.�"-�"�----------- ---------- -- ------- •---- JOA IN 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.CG. i