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APPLICATION FOR SANITATION PERMIT Permit No.'/_% /q...G_. (Complete in Duplicate) // Dae 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 3-- - � CL �2- --------------------------------------------------------------•----------------------- I Owner's Name---------------F L----------- ---------PEAK��-r------ --------------------------------------- ----- -- --- -- Phone------------------------------------ Address............ -----------------------------------Address.-......_... 2.5-5�------------�---•----- U_CA4-_t_>--------------•---..sTac.,...._...--------------------•-----------------•--------------------------------- Contractor's Name------------------------------------ ---------------------------- Phone----------------------------------- - -------------------------------------------- Installation will serve: Residencepartment House E] Commercial E] Trailer Court E] Motel E] Other E] Number of living`units: _ _____ Number of bedrooms 1------ Number of baths __I____ Lot size ------5d-----14_I_V______-____.________________ Water Supply: Public system Arolocommunity system ❑ Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe OfOHardpan ❑ Previous Application Made: Yes ❑ No Vo� New Construction: Yes,o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . A (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 10 Septic Distance from nearest well_MDNr1 .Distance from foundation----�fl-----------material-----F1).:.�?________ No. of compartments �,Z ___.___.__ ize__ p ,r � _�.�_x__�.__-:-._Liquid depth----- - ----------- Capacit Disposal Feld: Distance from nearest well,-NQ_W7-Distance from foundation-----10- __._...Distance to nearest lot lirtq____ Number of lines_-__ 'ZOE3P =_Length of each line------- ----Y _ .Width of trench -j_.-_ �X7.Vpi Type of filter material--, tG____ iZt.�epth of filter mat ---------- length.__________ ,;,- l �� Seepage t: Disfaetnearest Distance from foundation_ _J_�_________Distance to nearest lot •'� -__�_ be - Linimq material_ ---DOCK Depth---- --Cesspool: 1 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):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- �------------------;------`------------------,---------------;-------------------------------------------------------------------- ------ -----------------------�-;y-----y-------------------- ------------------•--------------•--------•-------------------------------- ----------------------- ------------------------------------------------------------ ---------------- ---•----------. ----------------------------------- ------- ---------------------------------------- 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. le2_0 ------- � -�J r --------------------------------------------------- (Signed: --------------(Owner and/or Contractor) -F.gY- =�-----SC ,�----------------- 1�-L !_4_I-'tT_(Title)-------------------------------------------------- - (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 ACCEPTED BY--------��R40-------i---- ---------------------------------------------------------- DATE------- rL -------- ------ REVIEWEDBY---------------------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and or recommendations--------------------------------------------------------------------------------------- -------------------------------- ------------------------------ �.-P - -4�? 't -- -------FT :5 Y r.� y� �e� /� �/ -- --- -------------------------------------------- ---------------- -------------------------------------- --------------------------------_Fl i _ -.' ___.__l_ _ _ _!_�_..---------0"-1 --------- ------------------------------------------------------------------------------------------.------ ------------------------------------------------------------------ -------------------------------------------------- - ------- -------------------------- , FINAL INSPECTI Y: -- - - ---------- ---- ------ Date--------- ""� r ----------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-7-2M , Revise, 1-57 FY-CO.