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rUK Ul•rI-L USE: --------- , -•---- -----------------__._....---...._- ----------- APPLICATION FOR SANITATION PERMIT Permit No. . � a� - - ----- - -------------------------------------- (Complete-in Duplicate) -------------- This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. /-1? 3 - f-70—c f.2.5 S - Ag f_AX4-4-e6i S7' ' 'r .L.{_ JOB ADDRESS AND LOCATION----L _4 _�___+ ._ .-- T'-V--------- /�/-,--y +,( LLL[._ -5;- c-f +-------till Owner's Name---c`q_�S_a r'` _ _�q ' ! r I• ' ' i-{`J ""te�ll n '�-' - V-=-----N------------ ------- Phone-----------J---azv Address 1` - •----•--------- d----- _ �� `"'` ------------------------------------------- Contractor's ----------------------- Contractor's Name---- X4.5 c v� `----------------- ----- Phone------ ••--------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _- ----- Number of bedrooms -------- Number of baths-------- Lot size --. V._4._�K__- n o s ` Water Supply: Pubiic system ❑ Community 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: (If yes,date............. ..... ) No e New Construction: Yes ❑ No R �' FHANA: 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 -----______00 _....'_--.-______..._.___--___. No. of compartments---- -10l"---...---Size------------------- -----------Liquid depth--------- -- ---- --------Capacity------------•--- Disp�o,s/al Field: Distance from neare well__/,JP--.....Distance from foundation_ .'___• -f Distance to nearest lot lina__�_�..___ E Number of lines__ ------ - -_--�--_---Length of each line_'_____.._ _eaa _ _._.Width of trench.-___ Y Type of filter materia!_-Ra,C__.._-_____-Depth of filter material- _11......... length.....l.._` __7 �.__...___ t'1 Seep? e Pit: Distance to nearest well__./.09---._._-_-Distance from foundation----�L .__._._.Distance to nearest lot line_.__X-_/--.._ p Number of pJs--- ---r ......_.__Lining material-----/..a,__VAKY-S• p Ji1'1 i. ¢e: DiameterlC�t ------ C-� 71 Cesspool: Distance from neares ell ._-------__--_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)_------_----------------.--------------------------------------------------------------------------------------------------- ---------------------------------------------------------- = ----------- ------------------------------------------------------------------------------------------------------ -: ---------------------•--------------------------------------------------------------------------- ----- V] - 1-------------------------- 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 District. (Signed) t s ce-<,---- ------------- --- - --------------- -----(Owner and/or Contractor) Q BY:------- �-�'t'•`-�-=�--- - •--- - .----- ----------- ------ - ---------- ------------ --- ----{Title}- ------ :..t.- - �- ---- �-- - ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / DATE._-LC7� --- - -- REVIEWED BY----- ----------------------------- ------------------ -------- ---------------------- -------------------------------------- DATE............................................................ --------- -------- BUILDING PERMIT ISSUED---------------------------------- DATE.------------- ---y.l} Alterations and/or recommendations:.lfG__.. -__-.-.. u�-_- .-- -- .---_-Q-_____- ./D.JI[-4 - � - --- -------- , �! - - ------------------- -Lvtd/ aC_1_. .►--- --- I- - - --------------------------------------------- - -------------------------- -------------- --------- ------ -- ---- --- FINAL INSPECTIONBY:-___ .� f/ Date---- - SAN JOAQUI LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguord Press