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FOR OFFICE USE: , 6 6--c-_--------- - APPLICATION FOR` SANITATION PERMIT Per No. ,q,�� ----- ---------------------------------------- 7 --`-- (Complete in Duplicate) Date ----------------------------------------------.-------_-- This 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 wiaComy OrdinanceNo. 549LWAI JOB ADDRESS AND LOCATIONS�iC�G'✓------ -• � �� r �" v� y Owner's Name-- � f�1-- � �qL..�/ --------FRIIi- 7 -- 001-------------------------------------------- Phone-- --------------•--- Address /.��d� ll- (90/�,.�rQV A-Y-- f -Q. _r__..-.0-,fZ--�-------------- Contractor's Name------------- . ---- �.-11lt9 Phone.. $ .gSaAlI�L Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [__1lMotel El Other 0 S 14Eb Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ---1---Ake-----------------------•----------- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table 7S�-_ ft. 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 New Construction; Yes [:] No Jam. FHA/VA: Yes 1-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:) r Septic Tank: Distance from nearest w I__ ke Distance from foundation--a-0........ '1 ----._Size------ Materi �.__ No. of compartments---r .--------- y- Liquid h__.5� .....___.._--Capacity.- ---X-- ---------------- dept ------ � A Disposal Field: Distance from nearest well.J. VNIZ1 .Distance from foundation,3-0..--------Distance to nearest lot line------- Number of lines___ Length of each line--7-57-4 -- Width of trench..�_._e_Jl_-___________-___ 1i �f g Type of filter material_j -- ---_--- Depth of filter material____�.�____--.--.-Total length__.____f-�----------------------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------_-.---- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter.---------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining material------------------- -_.___._________- ❑ Size: Diameter----- -------------------- - -- ----Depth------- --------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well---------------------------------_--------------Distance from nearest building-------------------___________.__.--_..._. ❑ Distance to nearest lot line ----------- -------------------- ---------- c "de nd/ r rep irwg (descri ----- -�---- -- - - - ---------------- - -------- ---- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ certify that I havepre ared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe laws, and rule an regulation of the San Joaqui ocal Health District. f (Signed)--------------------------------- - - -- - ------ --------- ,- ------ r- p --------------------------------- IoW and/or Contractor) :M.�onreverse i B - -------------------------(Title)-- ---- - ------ ---- - -..._...--------- I . (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be plat side). FOR DEPARTMENT USE ONLY 4DATE ---- i ,!� ��. APPLICATION ACCEPTED BY------------ ------------ --- �2 —�� ----------------------------------- - / IREVIEWED BY-------------------------------- ------------ ------------ -------- - ----------------------------- -------------------- DATE--------------------•--•----------------------------------- BUILDING PERMIT ISSUED--------------- DA•TE------------------------------ ----------------- -- Alterations and/or recommendations:-- j------- -----------------) ---------------------- ---k-r----- --- ---------- ---------- ----------------- ------------------ --------- ------------------------- ------- -------- --------- -------------------------------------------------•---------------•------------•--------------------------------------------- ------------ ----- -------- Z ��DateFINAL INSPECTION BY:. - SAN OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.Cr].