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rUKUttlU U5: ------------------ _ - ------------------------------- ---------------- APPLICATION F R SANITATION PERMIT Permit No. ;Z11-/ ..5_ ------------- ----------------- ---------- ------ (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. 'J JOB ADDRESS AND LOCATI tON- j1QC -_u -lZo - - --------------•---------------- Owner's Name •---wlx�---- ---- ------------------------- Phone.---------':- Add ress..------•---•----•-------; -------------------7- Contractor's Name = :Q ----------------------------------------------- Phonjc_dlCto/ . Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ `'V Number of living units: --/---- Number of bedrooms _.%- Number of baths -1---- Lot size -------- Water ---.- -Water Supply: Public tsystem ❑ Community system ❑ Private []�' Depth .to Water Table _ ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe EEt—Hardpan ❑ Previous Application Made: {If yes dote_,.-..-._.-._--. --.I No [� New Construction: Yes No � : ❑ ® FHA/VA: Yes ❑ No'�n TYPE,OFvINSTALLATION-AND—SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation- ------------------Material .._--.--------------- ------------------- ------ �6- No. of compartments--------------------------Size--------------------------------Liquid depth--------------- ------Capacity-•-------- ,c�stz (^�� ll sposal Field: Distance from nearest well_---�Jl. -------Distance from foundation.. --- -__--.----.-Disfiance to nearest lot line--- ------------- Number ofXnes--------3------------------ ----Length of each line-------�-D--------------- �---------- ---- -Width of trench-.----- -Type of flter mate ria♦�3.Q" q " Depth of filter material____ _-__---Total length------� ----------------h Seepage Pit: Distance to nearest well---------------- --.-Distance from foundation---v---------------Distance to nearest lot line __..---_.----...- El , Number o pits----------------------Lining material------ ------Size: Diameter-----------------------Depth--------------------------__---- Cesspool: Distance from nearest well----------- ------Distance from foundation....:...............Lining material------------- __----.--_---._ ❑ Size: Diameter---------_ Depth;r...�,.�:-----:r=:�.�;...�p -.-f:•�.---.-: ------------------ -.-_ -----Liquid Capacity-- -------------------------9als.. Privy: Distance from nearest well ---- ----------------- -------------------.- . Distance from nearest building-,- --- ---------- - - ❑ Distance to nearest lot line-------------------------------------------- = Remodeling and/or repairing'(describe):------------------------------------------------------------------------------- --_w ------------------------------------------------------ ----------- -•------ 4 : ------------------------------------- ---------- ----------------- 1 -------- 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)= ------ ----- -- - - ---- _ _ -- - -- -- --�------------- ------- ------- --------- ------------------------- -{Owner and/or Contractor) By------------------ ---------------------------------------I---------------------------------- Title of plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP NT USE ONLY APPLICATION ACCEPTED REVIEWED BY --- ------ --- --------------------- ------ DATE BUILDING PERMIT I556 D __________ -------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:.__-'_---_._.-__ ----------------------------------------------- -------------------------------------------------------------------- ------ ------ --------------- - - --------------------------------------------------------- --------------------- FINAL INSPECTION Date--------- AN J QUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Streets 205 West 9th Street Stockton, California Lodi,California !-Z Manteca,California Tracy,California V.P.CO.