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FOR-OFFICE USE: _ r -------------------=------------------------------------- p� APPLICATION FOR SANITATION PERMIT Permit No. . .Q.. t (Complete in Duplicate) Date Issued ___.___ � IkI This Permit Expires 1 Year From Date Issued _.___ Application is hereby made to the San Joaquin Local Health-Di&bkt awrmit,_to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. /147-C4 04 E 51ba nn JOB ADDRESS AND L2�_ .ATION _V_�T1j_q---_--3-ii-0_...51 F4_w �-... --.----_A � .lv....._F- -_�..._. Owner's Name------------.I_ !_ �5.N....... ..,.........R_ ------ Phone.3-6 N t Address---------------�`�� ----•--... � ......N.&N-.....00A Contractor's Name_l��/11T" C_/ ? PT C----.`,.. RPL----------••------------------------------------ Phone.... Installationwill serve: Residence jEr Apartment House ❑ Commtrl:ial '❑ Trai er Court E] Motel ❑ Other ❑ Number of living units: 1:..... Number of bedrooms ;?--_ Numbet of baths .- ._-._ Lot size ....AC _�------------------------------------- Water Supply: Public system ❑ Community system ❑ Private eiDepth to Water Table 1__ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loan-`E] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑. Previous Application Made: (If yes,date_-_.._--_-_-.._._-) NoA?-*"New?Construction: Yes E51"No E] FHA/VA: Yes F-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from ridarest well ------Distance fro fouRd tion....-�__-_-.-.mat er I�Rabwop�_.'Ti�i�ilV�o- � � No. of compartments'_'_:__. .};Size__��___. .f _Liquid depth-_-__--_ ..... Capacity_ ftpctDO Disposal Field: Distance from nearest well---- 47..__Distance ffem foundation..../Q-___-----.Distance to nearest lot line................. o� EXtST�XC( Number of lines..........1..._ _-------------length off0-------------- of trench-------Z_.----.--.----.._r.... Type of filter material__ O.G- ---.Depth of ?filtef material------1.`1.7----------- length_-_-------------------vz__..._-.- V1 Seepage Pit: Distance to nearest well---------------------- f-F&M foundation_.___---_-__-_-.__•.Distance to nearest lot line................. ❑ Number of pits----------------------Lining material----------------_------_Size: Diameter-------------------.---Depth------.------------_.:........... Cesspool: Distance from nearest well-----------------Distance from founds#ion---------------------Lining material._ ..------------- M' . ---------- E] Size: Diameter.---------------- -- -- Depth----- ---------------------------------------------Liquid Capacity------------ .4-- --------.gals. T Privy: Distance from nearest well-_._... ----- -------- ----- ----D43tance from nearest building------------------------------------------ F1 ..--- -__..___ __-----. _-_---.❑ Distance to nearest lot line--.---- ----------- - ----------- •...........------ ---------- -- -- -- ------------- Remodeling - ---------Remodeling and/or repairir (describe):---------------------------------------------------------------------'-----------------------------------------------------...................... ------------------------------------------------------------------------------------------------------------------------- ----....... ---------------------- ------ ---------------- ------------------------------------------------------------------=------------------------------------------------ ----------------------------------------------------->------------------------- ------------------------------------------------------------------------------------------------------- -----------------------------•-------------------------------------------------------------------------------------------------------------------.......------------------------------------- :. --------- 1 hereby-certify tfiatl Wave preparod this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the'Sen Joagi lei"ideal P earth District. (Signed)------ _ . . - ---- -- -- .._--....(Owner and/or Contractor) - -------------------------------------------------------- ----------------------------------------- ----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-----T__)K,0__• ------------------------------------------------------------------ DATE------- --a�S b REVIEWED BY. DATE ------------- --- BUILDING ----------------------------.DATE,.-----------fr..:...... -- -----. Alterations and/or recommendations: -------------------------------------------- -- --•---. •• -•-• ----._...__ . -------- -----------------------------------------------_ ------------------ ------ ---------------- .............. . = 1—-------------------------- -------•-----•------•---------------------------------- ---------------------- --------------------------------------------------------•---------------------------------------------------------------------- FINAL INSP -_..._ 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 ES 9 REVISED B-69 3M 3-'63 F.P.CD.