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FOR FFICI3 USE: r L _ APPLICATION FOR SANITATION PERMIT Permit No. a..l _.�...... (Complete in Duplicate) f�Z --------------- ----- _ __._-- This Permit Expires 1 Year From Date Issued 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 ma a in colmpliiaance wiithf County Ordinance No. 549. ,, A4TC '_ JOB ADDRESS AND LOCATION_-------[- i.--.- Va_T._4tv------.�-�--:------ -[- -----.---/ --/ Q-- -_.0(,;css`., Owner's Name--------C RLO-------M-•-,9A-e --_A(?_7-.-�`�C0- '---------------------------------------- Phone------------------------------------ Address --------RT ------nQ-x---------1--e:.�----A-------------MT�.....'------------------------------ Contractor's Name--Fr 13f—=- -DEMRMTNZ--D------------------------------------------------------------ ------- ----------- Phone--------------------- --------- Installation will serve: Residence EApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I--- Number of bedrooms 3_ Number of baths _3 Lot size ___---��^ / _ -)- Water Supply: Public system ED Community system E] Private Depth to Water.Table __7.5__ ft. Character of soil to a depth of 3 feet: Sand ®/Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2<New Construction: Yes ❑ No ❑ FHA/VA: Yes� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__='50-___Distan e from foundation------��'____.M teri �— No. of compartments____�? _Size-�X_I Q.X Liquid depth__.�f__� _ __Capacity- ---Disposal Field: Distance from nearest well---- Distance from foundation_____! ___-___.Distance~to nearest lot line___________. Number of lines------------S___________________Length of each lineP'�.�--_ate__-Width of trench-----3_�___....___.-__ Type of filter material----�-�C}t_Depth of filter material---41- I` Total length = ........ Seepage Pit: Distance to nearest well_ _ -____ ____Distance from foundation-___-_---_____.-__.--Distance to nearest lot line----1�__r-_.. ❑ Number of pits--.-------------------Lining material----------------------_Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------___._______-________________ Size: Diameter- ------------------ ----- ------De th---------- --- - :------/---=--------Liquid Capacity al Privy: Distance from:nearest well----------------------------------.--------------Distance from nearest building__..-.__________.__________.___._. ❑ Distance to nearest lot line-------- ------- - ------ ----- � ----------------- ---------- ---- --- - Remodelingand/or repairing (describe):--------------------------------------------------------- ---------- _----- ------ ------ ---- ---------------------- . k :. ______ _____________ _ ___ __ _______ __________________-------------------------- ----------------- ,,7 ______-_____.._____ _ ___ -_ _________. _ ____________________ _________-------------------------------------._ --------------------____.-___ s------------------------------------ . I hereby certify that I have prepared this application and that the weak will be done in•.accordance with San Joaquin County D' ordinances State laws,'and rules and regulations of the San Joaquin Loc4HealtWDistrict. (Signed) - ------------- ----------------------- -----1 ------ ---- ----- ----------- - --(Owner and/or Contractor) BY: ----- - --------------------------------------------(Tiifle)---------------------------------- ---.._ ------------- ------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------F5'E ---------------------------------------------------------------- DATE----------{ 5 ' REVIEWEDBY = -------------------------------------------------= --------------------------- DATE----------------------=---------•-------------------------- BUILDINGPERMIT ISSUED----------------------------------- ----------------------------- -------- '----------------------- DATE------------------`----------------- •----------- -------- Alterations and/or recommendations:---------------------------- --------------------------------------------------------•------------------------------------------------------------------------ ------------------------------------- --------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------- _ ---------------------------------_ _1--_---___-__y'__________._____._--____.___.____._-__-1_________1 ._. .----------------- -------------------_______________________________________ ____ter ----------------------- . -----------------------------------.----------------.___--_._-__._.____- FINAL WSPECTI :. 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.