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i IOR�OFFIC SE: . - ate ------ - - _________________________ ___ ___----------------------- APPLICATION FOR SANITATION PERMIT Permit No, 1; .Mlz --------------------------- --------------------------- (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 ®,��____�1� _-e �*• _._ __ --------------------------•--------- ---------------------- Owner's Name___---CLlr�/ sc__ —7 �/ -� ---------- ---- Phone- - j Addressa�" �¢� L --------------------------------•----•---------------------------------------------------------------------------------- ------- Contractor's Name. - -- --,---------------------------------------------------------------- ----------------------------------" ---------------- Phone----------------------------------- Installation will serve: Resi encu Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ Number of bedrooms �--- ,43-- Number of baths (�__ Lot size ___4*_ _ ,y__j.7_- ' ----------------- Wafer Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table ___._-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,dote-----------_________} No ;K New Construction: Yes 'T No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION .AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_//h-------Distance from foundation---fe__._......Materia!__c_GA ky�------_________ No. of compartments __. f - P -- Sizea -Liquid depth - ---- ----Capacity--fes _e Disposal Field: Distance from nearest weil�l�,.____Distance from foundation-J4--- ..._Distance to nearest lot line____4J-1_..� [ Number of lines------_ Length of each line_____._ _ y •�------------ -----=-- ----�---- .Width of trench....�Sl"---4✓j.--3-�'-------- Type of filter material_-_ _ s_ _ _ '"`_Depth of filter material__A_P.y----------Total length_..._____ so__--__ 1'l- " aa 1 I Seepage Pit: Distance to nearest well PJI7_.___-__Distance from foundation____�SZ________Distance to nearest lot line---I$�___.._____ t Number of pits------- -__-Lining material__��.� _Size: Diameter_:_-°�--______-Depth__-__, _ __.____...____ Cesspool: Distance from nearest well-________________Distance from foundation-_----------.-------Liningmaterial__._ .__._. ElSize: Diameter-- ------------------- -- --- -------Depth--------------------------------------------------- Liquid Capacity-X ---------------_gals. S- Privy: Distance frorri'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, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. (Signed] _�LC��-- �Ecrt +r ------------------------------------ ------------------------------r------------- ne and/or Caritractor) �r By:---------------------------------------------------------------------------- ---------------------------- -------------------------(Title---------------------- --------- ........................... (Piot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY W 144 I APPLICATION ACCEPTED BY DATE �-- �� -=------------ ------------- REVIEWEDBY--------------------------------------------- = ------------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED---------------I------------------- --------------------------•------------------------- ------------- DATE--------------------------- -- --------------- -------------- Alterations and/or recomrnendafions:------------------------------- ----- -------------------------- ------------- - ------------------ -------------------------------------- - =- ------`-------- ----------------------- --------"----------------- -----------------------------/-=----------------------------------------------------------------------------•- FINAL INSPECTIONDate G .......... ------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy, California F.Rca.