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,,FOR OFFICE SE: r. ' APPLICATION FOR SANITATION PERMIT Permit No. .. 3.. - ------------------------- ------------------------------- (Complete in Duplicate) This`PermitEz'iresS-Year From Date Issued'"t 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. E # . JOB ADDRESS AND LOCATION_._._��---�------�A.SZ-_--IAI•$1�.•s�------------------------�.`.�----�------ - _N_A -*%_--- •�8.: ----------------- �s --------------- Phone__ Q. Owners Name._-- --------------------�-- Address...._.11l�._____..,_.. _ ----- •-----------------••....---- -----•--- Phone................-................... Contractor's Name......L`LjL1%.A-L�1-------------- f ----------------------------'--- Installation will serve: Residence S Apartment House ❑I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '__t_. Number of bedrooms --la-_ _-_ Number of baths _ --- Lot size __. a_�.._.--?S_ ... .i_4_,�_______-__;_____._ .- Water Supply: Public system Community system ❑: 'Private ❑ Depth to Water Table 4,17 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy loam ❑ Clay Loami❑ Clay El Adobe EL Hardpan ❑ Previous Application Made: (If',.yes,date--------------------} �No'(� New Construction: Yes No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i � tt Septic Tank: Distance from nearest well_3ns_Uj9ADistance from foundation------ tiQ„d_u _u1------------------- . No. of compartments______--2----____'�__Sizo__��_X_q'_7«..-._..Liquid depth-.-.-----4�._.______.-Capacity__�Q_Q__ ' G Disposal Field: Distance from nearest well 8y0_u &Distanc-61from foundation_____ld --:_--_-Distance to nearest lot line__._......... I Number of lines---_-------3---------------------Length of each line-----------tc-4'----------Width of french--------74nj_% ----------- -- Type of filter material_____V_8_c.fs. -----Depth of filter material-------!.8_"'___"__Total length--------2---0-6� __________________ 1. Seepage a e Pit: Distance to nearest welLlnp_t--_& ante from foundation_-..BQ %4__Dis# } i _______..Distance to nearest lot line_______-yr___�_--._ t k,.--- ' Depth �c Number of,pits_____.___1-_________Lining material______!C_O_e.. Size: Diameter•___4__1�_Sa_._._-_ _______16_____________________.. Cesspool: Distance, from nearest well-----------------Distance from foundation--------------------Lining maferiaL___-_-_____-- ---------------------- ❑ Size: Diameter---------'------------- ---------------De'th•---------------'=._�__.__-_. -----------------Liquid Capacity gals. P Li 9 p tY Privy: Distance from nearest well___----_-----------------------------_------- Distance from nearest building--------------------------------..--------- ❑ Distance to-nearest lot line--- �_-' -� =- •- -{•--------- -------•----------------------------------------------------------- a Remodeling and/or repairing (describe):-------------------------------------------------------1-- -------• ----------------- ----------- -•-----------------------•- •--------- ----------- ---------------------------------------------•--•-------------------------------•---------- 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 Uncal Health District. I • -------#-------------------------- ----------------(Owner and/or Contractor) (Signed)--- - --------------- .,rw y....-�x»......rte-..-.,f—....—..n.r.»•.-r+�r�y F Ek 11 (Title) _______----____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc,., can be placed on reverse side). f FOR DEPARTMENT-USE ONLY r APPLICATIONACCEPTED BY'------- --------------------------- -----------------------------=---------- DATE-- ---------------------------------- REVIEWEDBY-------------------------------------------------- ---------I--------------------------------------------------- _._ DATE BUILDING PERMIT ISSUED----------------------------- --'- - T'= "-- - - DATE Alteratiofs and/� recommendations:----------------------------------- -----------------•-•---------•--•--------•-•----------------------------------------------------------`-••--.-...------ = 1 �Q - llf-.....Y/ -� f - -- - ---- ..__..__...2 --------------------------- --------------------------------------------------- -------------------------------- ---------------------------------------------------------- � t FINAL INSPECTION BY: Date`' -' - ' .].1 �D SAN JOAQUINfLOCAL HEALTH,DISTRICT 130 South American Street 300 West Oak Street 124 sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Es-9 REVI6Ea e•59 F.P.ca,am s-so - ,