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FOR OFFICE USE: -------------------=----------------- ------" ----------- _ APPLICATION FOR SANITATION PERMIT Permit No, aflrrr _, --------�----_. <• f -/--y -fi'�"' ,i(Complete in Duplicate) ;i- - Date Issued""Jf--% "_.__4, __-_------__--__1-��-�(l �$�- - This 'Permit Expires 1'Year From tDate Issued = =a Application is hereby made to the San Joaquin Local Health Dl-�stri'ct fo�p rmifi to cons#ruct and install thew her in de ribs This application is made in.com liance with County Ordinance No. 549. E3b �jl: 'I ADDRESS AND OF � t JOB DRESS AND LOCATION1l-__�oQ�/.--_O,/ 1---- ----- pa_._ •` G_� ��_� S/.� IOwner's Name------- IV"T-�-` _/�,- e-l---'P--�-----~-------------------- ---------------------------- -------------- Phone.-------------------__-_---------- Address � K.21 . ... r�/ ----------------------------------------------------------------- Contractor's Name----------- s ------------------------------- -•--•---------. Phone---------------------------------- Installation ---••-•--------------•- -- - Installation will serve: Residence Apar+merit House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__- Number of bedrooms; ___ Number of baths 2____ Lot size _ . !�/_ _-.____._ Water Supply: Public system ❑ Community system ❑ -Private Depth to Water Table 7,I11? ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: (If yes,date---------,_-.__..___) No 41[' New Construction: Yes EylNo ❑ FHA/VA: Yes kq--,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seweris available within 200 feet.) `"- f � Septic Tank: Distance from nearest well__ __.___Distance ffom foundation__! ___.____.Materg 'r�rf '/_______________________ I` No. of compartments__-A-------____:__Size f>b-____/,-1- X.Liquid dep6-----'r � Ca p acit Disposal Field: Distance from neares�j weft-S-P -___-Distance from foundation_ d___,___.Distance to nearest lot line...... _____ Number of iines------ Length of each line__ ____ _____.Width of trench-�--..__�;______..___________ .1 f Type of filter material kA_ Depfih of filter materiaL__� - ------- length_`' __________________________ Seepage•Pit: Distance to neareswell___� __ Distance fro fou atipn_ j _________ Distae to nearest lot lin ----- lee Number of pits-----_____------------Lining materiai___ _--- Size: Diameter. ...... 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-----,------------------------------------ I � ; O3 I ❑ Distance to nearest lot line �-------------------- ---------------- ------ -------------•------•---------------------------�; ' Remodeling and/or repairing (descrie�:- -`fr " -- r — y ----- -------------- -------------------------------------- ----------------------------------------------- ------------•--------- --------------------------------- ------------------------------------------ ------- ---------------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 r�anddlations of^'the San Joaquin Local Health District. (Signed)-------------------------------- -- r ----- - - - (Q or Contractor) r By---------------------------------------------------------- ---- -- ---- - - - --------------------------{Title) p (Plot plan, showing size of lot, location of sys In relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY - — - -------------------------------------------------------- ------ DATE------------. f-.-- ----.14- /--- --------------------- REVIEWEDBY-------------------------------------------- - ------- ------------------------------=------------- ---- DATE----------------------------------------------------------- y BUILDING PERMIT ISSUED_______________________ ----------------------------------------------------------------------------- DATE------------------------- ------------- - ------------------ -, Alterations and/or recommendations------------------------------------------------------------------------------------------------------•----------------------------------•- - ---------------- { r ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------•---•----------------------------------------------••--------------------------------------------- ------------------------------------------------------------------ - -- ------ --------------------- i I FINAL WSPECTION BY:----- ---------- Date. `' .... � --------------------------------------------- SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 134 Sycamore Street 205 West 9th Street h ' f r' Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cd. 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