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FOR OFFICE USE: ____-__________ _______________________-_--__ APPLICATION FOR SANITATION PERMIT Permit No. ... .5... ------------- -- --- -- tt (Complete in Duplicate) �T---�' --------- - ---- -- ( P P� ) Date Issued --------- ----- --. This Permit Expires 1 Year From 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 ��O�rrdinance No. 549. JOB ADDRESS AND LOCATION_.11)---UW--.1�/i1.------ Owner's Name -` ..� r.�_R..l4 --------------= Phone S� . �� Address ----•--• r------ Contractor's Name -(R:�.1_S-� ��= + Phone--�.Sa.6.��-(,?.0 7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: ---..... Number of bedrooms -------- Number of baths ----- --- Lot size ------ --._1�_ °. ----------------------------- Water Supply: Public system $ Community system ❑ Private ❑ Depth to Water Table 60— ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date--------------------) No % New Construction: Yes ❑ No gL FHA/VA: Yes ❑ No (L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank: Distance from nearest well_N A2E'Distance from foundation_.7�`-.------.Material....__ --------------------- No. of compartments-.--__-7-- .--------------Size.3.7�__ __-Liquid depth---57W_r ------ ---Capacity.�Q�.-6A.Lr Disposal Field: Distance from nearest well-Al-O&P—Distance from foundation---g. -.-_..Distance to nearest lot line... Is— �,.C?�.. Q4 Number of lines-_OW—C- C.,!__�-.._.-Length of each line_Z047 `--+�-_.--Width of trench-.�4......._--.---_--._.-_ O to Type of filter material.l_ ._- -iCK,..Depth of filter material--- -7—__-------.Total length_-_.---1.49-E1----------------------- Seepage Pit: Distance to nearest well----------------------Distance from' foundation....................Distance to nearest lot line--------------... V ❑ Number of pits----------------------Lining material-------------.---------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well--------------__Distance from foundation--------------------Lining material--_.._.--..-.-..-_-.-.-_---__._--... t "' ❑ 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)------4R�------ "� ••----------------••...... ----------------------------------------------------------------------------------------------- � ------- - - ---- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- I hereby certify that I have this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r s and re- lationsof the San Joaquin Local Health District. (Signed) �_A&Atc,__Vl I�A ---- ---- (Owner and/or Contractor) RO / - - ----------------- ---- By: i� � `' -4� (mac c (Ti+le)------- "'-------- - ---- -- --- -------- (Plot plan, showing size of lot, location of system in relation to well , buildings, a+c., can be place n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- ----- ----- ------ DATE-------2 %4._ s REVIEWEDBY---------------------------------- -- ----------- ------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- --------------------- Alterationsand/or recommendations---------------------------- ------------------------------------------------------------------------------------------•--------------------------------------- -------------------------------------- ------------------------------------ --------------------------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------- ------------------------------------------------------------------- --------- ------------------------------ --------------------------------- ----------------------------------------------------------- ---------------------------•------------------------------------------•-----------------------------------------_-------------- ------------------ ---------------------- ------------------------ ---------------------- ------_---------------------1------- -----------•------- -------------------- ------------------------------------------- FINAL INSPECTION BY: ---------- Date------------------- �� ' - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.