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FO'I OFFICE USE; -------------------------------------- --- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.1- --3_J ---------------------------------- -- - __- ----------------- -- -------------------- --- ----------- (Complete in Duplicate) Date Issued -5 _ S. -------------,.......---------------------._._ 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 ma a in compliance with Count Ordinance No. 549. �,,J : �7-2.00--C77 � _ _ JOB ADDRESS AND LOCATI, N..::- _-�----- -- - -=---�`i` �---:--- ----- -------- ---------- ----- - i � Phone-Zr ----Z , 3 Owner's Name------- /--' r`� f - f.� AddressI - 3_= # ---- �` /�[-Ca ��gA ,. ._. r : ° 1==fes ._�'1_ ,Y, _RA. �► Contractor's Name___ ___-.__-__ Phone_ - _7:'1_ 4.6 .- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms _umber of baths ____ Lot size ____------------------- Water Supply: Public system ❑ Community system ElPrivate B' Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan [d}� Previous Application Made: (If yes,date____-------_--------1 No New Construction: Yes ❑ No �HA/VA: Yes ❑ No ®_ TYPE OF INSTALLATION AND SPECIFICATIONS: _(No'septic'fank or cesspool permi:R d if public sewer s available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- ��f�'.- 1.lh)�-- No. of compartments - -----------•- ---Size--------------------------------Liquid depth--------- -.CapacitY---------------- ---� Disposal Field: Distance from nearest well____., ..-Distance from foundation.._.:f. --------Distance to nearest lot line--s------------ \„i E)(UyTj/4& Number of lines------------I--------------------Length of each line----------7 -------.Width of trench.--------. _ ----------------- '� 1 la D ° Type of filter maferiaI__F0_�h`�----Depth of filter material.....t-I-f_.______._Total length___.________75-__!-------------- Seepage Pit: Distance to nearest well-__f --------Distance from foundation____ 1V-------Q�stance `--Depth nearest lot line--.-,s __.._ [+ � Number of pits- ----I-- --- - Lining mate ria Lh------Size: Qiameter.: _X.. .__'.Depth____... _______________.__ Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material-----------______..___________._.. { t ❑ Size: Diameter---- --- --------------------------Depth------------ --------------------------------------Liquid Capacity----------------------------gals. P Privy: Distance from nearest well___.________________________________:.- __._._---Distance from nearest building____._____.__-____________.____._____-- ❑ Distance to nearest lot line------------------------- -------------------=------------------------ ------------------------------------------------------------------- - Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------- --------- -------------------------------•------------------------ -----•-------------------------------------------------- ?h1T1. f__p:,-.-:-,5 = . ------------------•---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ -------------------------------•------------------------------------- ----------------------------------------------------------------------------------- --------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. (Signed)-- �A« f-1` 'Qli( .l T—v--- PkNE -: A_R ;?. ------------------- -----(Owner and/or Contractor) ----------------- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY--- --t -------- ---------------------------- --------- DATE---- � -------- C>-------------------------- REVIEWEDBY-------------------------------- - ------ - - -------------------------------------------------------------------------------- DATA=------- -------------- ----- ----------•------•------------ fBUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------- ------------------------------------ -----------------------------------•-------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------- ------- ----------------------------------------- - - --- ----------------------- -- --------------------------- ------- ------------------------------------- - ------ --- -------------------------- ----------------------------- -- � ------------ ' %' FINAL INSPECTI`O BY -- --------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycar"ore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cr3.