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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) i -- Date Issued __-.-/�7��1_ 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. , JOB ADDRESS AND LOCATION.,------_ Owner's Name-----DA .F--------COFF -----------------------; -------------------------- ---------- PhonEP9D Addressi -0. i----.u - �--- cl..0 ' Contractor's Name QV11N - ------=------------------------------------------------------------ --------- ------ Phone--------------------------------- Installation will serve: Residence ❑ Apartment House ommercial ❑ Trailer Court ❑ Motel ❑ Other,�� Number of living units: -1---- Number of bedrooms ______ Number of baths _r1r__ Lot sizer j -77---j-7S` '---------- Water Supply: Public systemommunity system; Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ 'Clay Loam ❑ Clay ❑ Adobe JW Hardpan ❑ Previous Application Made: Yes ❑ No URI""New Construction: Yes•'�Na ❑ FHA/VA: Yes ❑ No Zjw--`- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) �T�-- Septic Ta Distance from nearest wellr__Distance from f undation____/19_______-Mate -al--- - _ _ ------ No. of compartments....... ---- di?th________ ________Caacit p Y---� f� -.____$iz F_e 4 i uid e j_, ____ 20- ---- q, f - Disposal Field: Distance from neare t weEf__'-+_____._Distance from foundafio`n___�>l�_____._-_Distalnce to nearest lot line-___ ((�� ®/ Number of lines_____ _______________Length of each�€ine_ ----61-------Width of trench-----2 - �_ aV -j---------------- Type of filter mat ria) � —--------Depth of filter material__,/0-_11 ---------Total length--------y-�-10----_---------------- 01 Seepage Pit: Distance to nearest well----------------------Distance from foundation__________.._._.___.Distance to nearesf lot line_____._______ ❑ Number of pifs----------------------Lining material-----------------------Size: Diameter-----•-------------------Depth---------------------------------- 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----------------F__________-_----------._. ❑ Distance to nearest lot line--------------------------------------------------------------------- --------------------------------------------- ----------------------- Remodeling 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 §nd regulations of the San Joaquin Locai-Health District. . -- s , (Signed).______ _(Owner and/or Contractor) B (Title)__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY {{ APPLICATION ACCEPTED -------- 1 ------------------------------------------------------ - -- DATE------ � 1"'._��,� _ ---------------------- REVIEWEDBY------------------------------------------- ---------------------------------------------------------------------------------- DATE----------------------------------------------------------- { BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------ Alterations and1/or recomm/°endationss':_PL.l �V—S--__CIMNf� / -----�?' ._j_.'` �___._iAl------ j1,r�}_+�S�_------�_-]�•1,`/1�� 9 r:A "` R. ------------ ______�I.X_----Bft-C ______`S/F-__.-_-r�__Jr^��__f___ _--____-____I.l_��_-r----_-_r--E_.�c0___.___--------.C'_�_f9_F_fi'?___^_l�?_5/__�a'�__��°_"_�_��.�„� Ug Lf f C 1}'I' -----== `�37:b -`------- 5__S0a1 --------ASA-T1-51 2 7I ----- t~ ,fes------r1WS . L ? i `�- CE = '—��' vui�c— p 1 � 7 � =��----------------------- y 't - Vit- _ = `� 1 ----- --------------- - -- ------- ��JJ / FINAL INSPECTIO — -- ------ - ----------------- --- -- Date SAN JOAQUIN LOCAL HEALTH .DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California J Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.