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FOR OFFICE USE: -------------- ---------- Permit No. ------------------------------------------- -- ---------- APPLICATION FOR SANITATION PERMIT �`�-----�-�-- ---- ----------------------------- (Complete in Duplicate) Date Issued ------- ------_ �h.. _ is 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 described. < This application is made in compliance with County Or mance No. 549. coTrq e Pd �. JOB ADDRESS AND LOCATION- --------�3 ---------- � --- / ni' .J.rk ' r� .-�� --�:r Owner's Name-------AVO Vii^ ------------- -=----------------------- ---- - --------------------------- ---------- Phone-------------- --------------------- Address----------------- &0tT -?Q---------. s -------- n---_4q_jdu°s5----X-fT---•---------------------------------------------------------- --------------- Contractor's Name-------4%-lkcv---- ---------------- = �^ ---------------------- - --.. Phone..--------------------------------- Installation will serve: Residence Apartment House EDCommercial E] Trailer Court ❑ Motel ❑ Other [I Number of living units: ___1--- Number of bedrooms __ -- Number of baths --..1- Lot size 7------------------------------ Water Supply: Public system ❑ Community system ❑ Private Rr Depth to Water Table -o'"1~G_ ft. Character of soil to a depth of 3 feet: Sand ["Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote---------- .------._) No &r New Construction: Yes E"'No ❑ FHA/VA: Yes ❑ No F�� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) --------.Material-- - ..eL.Ar-r ----Septic Tank- Distance from nearest well---��------Distance from foundation----.42 ----~�- �'J Size Liquid depth S_/- Capacity * 'Q- tg 1 No. of compartments--------------Q___. �.X----_ -- - � f Disposal Field: Distance from nearest well-_:O ..._.Distance from foundation-- 1---�._..Distance to nearest lot)ine----- -------- Number of {fines � ---- ------------------- .----------- I/--------- Width of trench----- ----y--------------------- Type of filter material-_RO.Cfc�----------Depth of filter material__/s---------------Total length-----.- 5'Q---.-----------_--------- I 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 --.._._-___-------.--------__----- E ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity - ---------------------- -gals. Privy: Distance from nearest well----------------- ----------------------------Distance from nearest building------------- -------------------.-------- DQ ❑ Distance to nearest lot line--------_------------ ------------------------------------------------------------------------ ---- Q Remodelingand/or repairing (describe):------ ---------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- 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. -Se 'u ----- - -- Contract (Signed)---------- Y IR ----- ------ --------- -------- - { � or g ----- (Plot G.-_ ---------------(Title)---------- ----- --------..-..---------- --- - ----- --------- Y• --------- --- --------- -- ------ ----- --- (Plot plan, showing size of lot, location em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION AC=CEPTED B I -- ------------ - DATE � j REVIEWED T� BY-------------------------- ------- ------------------------------- - -- ---------- --- -------------------------------------- DATE----------- I BUILDINGPERMIT ISSUED---------------------------------------------------------- ---------------------------------------- DATE---------------- ------------ i Alterations and/or recommendations:------------------ -------------------------------------------------------------------------------------------------------------- - ---------------------------- ----------------- -------------------------- I ----- ------------------- ------------------------------- ---- -- i -------------------------------- ---------------- ------------ - - - -------- -------------•------------- ------------------- ---- , r `-�AL INSPECTION 134 `-� C Date- f� ------------- - -- -------------------------- FINAL INSPECTION BY: ------ �'--'-"-7- ------------------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 4 Stacklon,California Lodi,California Manteca,California Tracy,California I