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FOR OFFICE USE: T/off 9D 6 - - --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- - --- ------------------- ---- ---- ------------- (Complete in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made-to the San Joaquin Loca€ 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 AN LOCATION. --... " --------- tnll -----------------------------------------------------SAT---ROl' Owner's Name 1:__ j �-_1_P- _...... �� i Phone----------------------------------- Address----------6_12-- _-------:-H_194KA.R-------jW /_—_ATf+_RaR- ------------------------------------------------------------------------ --------- Contractor's Name L?LL K - --------- -��--�-- Phone. ----------•----------------------•------------------ ---------- - ..r_. d Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑. 4Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms -------- Number of baths __�___ Lot size .c _. �,1_ _x.-__ Jai________.____ _-.-_ s Water Supply: Public system LAr Community systems❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam RT-day' E] Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: (If yes,date-----------7....,.._),;No New Construction: Yes �No ElFHA/VA: Yes � No El r �-. -- - -e r..� -STYPE+OF;INSTAL-LAS'IONrAND.SPECIFICAT6O ��- ,.�..NS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) Septic Tank: Distance from nearest well___._- _Distanc ' from`foundation...'_' _- NlateT al__C"Q/IPGIT ------------- - - - , ,�- -----....__Size--- --• ----------Liqu€d depth--- -`�--------Capacity--/-�L.--_D©-"-- No. of compartments._._._ ._ ._ I � x>I�-x'� • Disposal Field: 'Distance from nearest well__C:,.-_ ,Distance from foundation=_��0--_-_-_.Distance to nearest lot line__5_-.._____ - __"..""`------'Lengtls of'each-line_0 '1f�''�-___ Vidth of trench-------5- z-r.________________ 'Number of {ines__'�:__.�. .._ Type of filter material__�Q_c ___Depth of filter•,material__.19----`_----x.rTotal length----------P7_s�-7----------------- Seepage Pit: Distance to nearest well---.--------- ..'_.--Distance from foundation--------------------Distance to nearest lot line--.-_.----------- 21— Number ._.---..__24rNumber of pits---------------------Lin,g material-----------------------Size: Diameter-----------------------Depth-----------------•--------------- Cesspool: Distance from nearest well -"."___-Distance from foundation---------------,___.Lining material_- ---------.-_--_-____._..-__-_ -- ❑ Size: Diameter ---_! -Depth-----------------------------------•------------__yl-€quid Capacity------------------------- gals. E t . i 0- Privy. Distance from nearest weil-------- c'-- ---------------------------- - ---Distance from nearest building--------------------------.------------------------------------------------ F1 Distance Distance to nearest lot line.------ "=---------------------------------------------------------I----------------------- ---------------------------------------------- f Remodelingand/or repairing (describe):--------------------- -------------- ------------•----------•----------•------------------------------------------------------ -------------------- ------------------•-•------------------------------- ------------------ --- ---------------------------------- -i'------------------------------------------------------------------ --------------------�---------------------------------------------------- ------ 1.1111 - - -------------------------------------- ------------ --------------------------= ----------------------- - r= t I hereby certify that I have prepaied this application and that the work will be done in accordance with San Joaquin County ordinances, State' laws, and'rules and regulations f the n Joaquin Local Health District. ---- - ------- - --- ----------------------------- AOwrter and/or Co or) ww�.w: y.—("* ""'�' .��y,.:n----------------------------------- - ------------------------------- -- --Title_ (Plot plan, showing size of lot, location#of sysiem in relation to wells, buildings,, etc., can be placed on reverse side). � F € FOR DEPARTMENT USE ONLY'k APPLICATION ACCEPTED BY----- DATE � -------------------- REVIEWED -�'��----�-��--'- -----REVIEWED BY------------------------------------ -------------------------------------------- ------------------------------------ ----- DATE------------------------------------------------ BUILDING ---------------------------BUILDING PERMIT ISSUED--------------------------------------------- --------------•--------------------------------------- DATE------------I•---------- ----------------------------- Alterations and/or recommendations:_- ____:�- ________ ___---_ ------------------------------------------ "I --"'"-"`-�`-""" -'------------------- -- ----- ---- - -----------• - ------ ------ ------------ ------ ------------------ �gr ,6 FINAL INSPECTI Date--- SAN ate-- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F•.P-00. f 3