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FOR OFFI,CtU§E: r` -------- _.' :.. APPLICATION FO2 SANITATION PERMIT Permit No. `.1 --- --------; ----- (Complete in Duplicate) Date Issued ------ _--------______---____--- I 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 Ordinance No. 549. �-s,� JOB ADDRESS AND LOCATION-------LI.---l- ------�_N.t/-�--D-V---------------zv! --- A-6lV Owner's Name----.-�>-Ir 1�_�_R_&b-------------- /IGS----- ----- Z_A_A1.--...--- . Phone .,r4.-U O--- Address-----•-----------I-0--4f. .--•----.111=1.----`/ ,�j Contractor's Name--------------•----F_AW g-kys-il---•---#--.. ............... Phan Installation will serve: Residence 1a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.)___ Number of bedrooms --� Number of baths __,._.. Lot size -__�D X_�O.Q`•-------------------------- Water Supply: Public system ❑ �ommunity system �rivate ❑ Depth to Water Table(01.0- ft. Character of soil to a depth of 3 feet:-San- ❑� Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe KHardpan C1 Previous Application Made: (If yes,date--------------------) No X New Construction: Yes ❑ Nog FHA/VA: Yes ❑ No J� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-�l�Q Distance from nearest well-----------------Distance from foundation.__--__--_-_-_-_--.Material------------------------------------ ---- _.._____� ❑�(5 / No. of compartments-------------- -----------Size-------------------------------Liquid depth------------- ------------Capacity----------- Disposal Field: Distance from nearest weIINBA_AZ-__Distance from foundation...Z--fl........Distance to nearest lot line---S-./...... ( Number of - -------Length of each line__--.5`a_`___.d Width of trench..Z_ `---------------Is. Type of filter material___ -_Depth of filter material------1_Q..-_-.__..Total length-_--____�___________________ Seepage Pit: Distance to nearest well._V_D-_A)-��_--_---Distance om undation__�.o__----___.Distance to nearest lot line---S -- Number of pits._40V-6-�_Lining material-"----Size: Diameter-33.." ---Depth- --�,-----Cesspool: Distance from nearest well_-___-____ ---Distance from foundation-----.______------.Lining material._____________--______-___.---- ❑ Size: Diameter---- --------------- ----------------Depth---------------------------------------------------Liquid Capacity----------------------------g Privy: Distance from nearest well-....___________________---______-._-...._._Distance from nearest building___._-__.--.--_.-_____-...__.____ ❑ Distance to nearest lot line----- -------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) 2? -- -------- ----------------------------------------- --•-•--------•---•-----•------------------------- ---•------•---- t ---�------ ---- -1--------- ---------------------- --------------------------------------------------•------------------------•--------------------=------------------------------------------------------------------------------------- ------- I hereby certif repared this application and that the work will be done in accordance with San Joaquin County ordinance a aw , and ru and regulations of the San Joaquin Local Health District. 1f _ _.>I -�_. �� ___ ____ ------------- Owner and/or Contractor (Signed) - S ( / ) BY: (Title)-- --------------- --- - ---- --------- (Plot plan, showing size o io:;t,;Ioca;-,on of system in relation o wells, buildings, etc., can be plateverse sde). FOR DEPARTMENT USE ONLY ----------------- t-GQ-- ----------------------------------- DATE---------- APPLICATION ACCEPTED BY_ �_ _� �_ �v ?' �� 6 REVIEWEDBY-------------------------- --------------------------------------------------- ------------==-------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------••----------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations--------------------------- ------- ---------------------------------1_---------------------------------------------- -----------•------------------------- -------------- -------------------------------------------------- -----------•----------------------------------- --- ---- .,--- =`-1-------- '�-t E�" ------------------------------- --- -__.-�--------•----------------------------------- ---------- ----------- --------------------------------•--•------------------------- ----------------•--------------------------------•------- ----------------------- ----------------------- 1010 FINAL INSPECTION BY-------------- ---------------- ----------- Date----- ' '6 ------------ ---------------------------- 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.