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FOR OFFICE USE: /J 3,.1 %- ` APPLICATION FOR SANITATION PERMIT Permit No. .�°�. -_- ------------------------------------------- ---- -------- ------ --- ------ ------------- u -----------------------------------------------.-------- (Complete in Duplicate), Date Issued /f ---------------------------------------------------------- This Permit Expires i Year From°Date Issued` i Application is hereby made to the San Joaquin Local Health District for a pen;if to construct and install the work herein described. This application is made ,iy,yncom�ypliance with County Ordinance No. 549. [ 1L. JOB ADDRESS AND LOCATION----------------725 ------F-704 .- V�'A�-----------------------------------4A_T.RJ3ae----------- (� Owner's Name----------1_-HIA14k __--= l T=------:-C --s------------ - ---------------------------------------- Phone---------------------------------- Addressk3�L.......P- .LM - --------------------`„-----`-----------•-------------------------------- Contractor's Name LL I-----•--•------------------------------ ---------------------- Phone----------------------------------- Installation will serve: Residence Rj'Apartment House ❑ Commercial ❑.I Trailer Cpurt ❑ I'Motel ❑ Other ❑ Number of living units: __#---- Number of bedrooms___- Number of baths . " Lot size ._--1 ------ -------7 ------------------------ Water Supply: Public system e,Community system ❑ Private ❑ Depth tozWater Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam el Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: {If yes,date--------------------l No Eg/ New Construction: Yes Zo<�o E] FHA/VA: Yes No ❑ ` =---•TYRE40E-4NSTALL-ATION_SAND-SPECIFICATIONS:' r�--=-..6°=-----i,� (No septic tank or cesspool permi:f+ed if public sewer is available within�200•feet.) . Material - ---�A/---- E_ Septic ank: Distance from nearer well-. �-�`!---Distance from foundation 'C __..--_. No. of compartments_`___-_----------.--Size---!YX .19 X-5-1 Liquid depth---- 7-----------Capacify--- Z- O .. Dis osal Field: Distance from neares well--- from foundation._-I ._---------.Distance to nearest lot Gne-15 ---------------- �' it p Number of lines----_- _----------------------_-Length of each linel�trJ�:y�� SWidth of trench.---- of filter material--- �. �_�.-_Depth of filter ............Total length----_---.-/F�------------------- Seepage Pit: Distance to nearest well---------------------------------- from foundation--------------------Distance to nearest lot line.------.--------_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------_------------Depth--------------------------------- r 3 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): -, ----•t ------------ ----------- ------ ----- --•-------- •-----•---------•--- ------------------------------------•--- -----•----------------------------------------------------------- -------------- ---------------- -1 1f,I t - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- 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 an Joaquin Local Health District. V 1 � 1 3 _.. (Signed) G _Lf C/ --- --fes ----- ------- -- -- - -- - - ---- ------(Owner and/or Contractor) — � •- �. . 13 . = �-- - --- -- -� ----� � --- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY.-- .,_--------------------------------------- DATE-------�-- - ----..--tj REVIEWEDBY -------------- ----------- ---------------------------------------------- DATE------------------------------- ------------------------.-.. BUILDING PERMIT ISSUED----------- ------ ------------h ---------:------------------------ ------------------------------ - DATE--------------------------- ----------------- --------------- ... ------.- -.. .:- Al+era+ions and/or recommendations:- --------------------------------- -_----.- -----•--- - ------------------------------•--:-•- •---- - � -----•----•------------------------ a ,.,s t N; ------------ --------------------------------------------------------------- ---- -------------------- FINAL INSPECT( - - 0 , ._.Date------------------ - - + .-- ct-(Cl -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 0.