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FOR OFFICE ISE: — ��`�'T x ---------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .../..1� �5 ' ------------------------------ -- -- -------------------- (Complete in Duplicate) -- This Permit Expires-1 Year From Date Issued bate 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. JOB ADDRESS AND LOCATION-------3`20-------IA�-----��f_SG_/� M`rc c------- /1/J - -------------- --------------------------------- Owner's Name f-J- --L =. --------- - irV - T 7 ?'�- Phone--01 � J y Address . . ._.ltf .�_-• - ..f S__e o - Contractor's Name------ -•----------•-- •---------•--------------------------- ---- ------------------------------------•.-. Phone---------=---------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Ej Motel ❑ Other ❑ Number of living, units: /----- Number of bedrooms _3--- Number of baths '_-!--- Lot size X-_ -------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ---V ft. Character of soil to a depth of 3 feet: Sand ff' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------------ -----) No ®'New Construction: Yes ❑ No P�-�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION 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 Ay/a"/Ny' No. of compartments------------ -------------Size-•------------------------------Liquid depth---------- --------- - ---Capacity----------------------- Disposal.Field: Distance from nearest well.�a____Distance from foundation___.,__D---------Distance to nearest lot line----��r lS�p Number of lines------- -- - --- Length of each fine--- --- - -..Width of trench----rr------, _--------- "V I / Type of filter material-47,12 Tk___---.---Depth of filter material_-----1 _____.-Total length---___-L-- O----_--_____-----. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_---- -----_ , ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------- 41 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-.---------__---------,_____--_ ❑ Distance to nearest lot line Remodeling and/or repairing (describe)---------- ------------------------------------------------------------------•-•---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, ndrules regulations of the S n Joaquin Local Health District. (Signed) A Y �X- ------------------------------------------------------- -- ---.Owner and/or Contractor ,. --------------, _ _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I b FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------T1_1-0--- --------------------------------- DATE---41�------ REVIEWEDBY - ------------------ ---------------------------------------------- DATE------------------- --------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------.- DATE------------------ --- Alterations and/or recommendations:--------- ------- ----------------------- ---- -------------------•---•------------------ ------------------------------------------------------ ---------------------------------- ---------------------------------------------------------------------------------- ------- ---------------------- ------------ ------- ------------------------ -- ------------------------------------------- ---- - ------- ---------- - --- -- ------ --- - ------------------------------------------------------------------------------ -------------------------------- cw +p FINAL INSPECTI -- l��o--------- - --- - -------- Date____ 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Streel 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.