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FOR QFFICE.USE: u ---------------------------- -- - - APPLICATION FOR' SANITATION PERMIT Permit No. .. .�. .. .... ------------ ---- ----- _-_.___-_.-_-- ` - (Complefe in Duplicate) ' Z 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 Ordinance No. 549. Ipp� JOB ADDRESS AND LO AT1ET14 ---------RD, !_ -...._.n-r_� ------- � ------- Q/ 5 U---------------------- Owner's Name�.P0F'_K_FL1._kj.'a------ � Phone q --------•-----------•----•--------•--•-•--.------ Contractor's Name----- -------------------------------------------------------------------------------------------- --------------- Phone----------------------------------- Installation will serve: Residence g2l"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms 3---- Number of baths J_-_ Lot size ---QACBA�;=------------------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A 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 g?"New Construction: Yes [?r"No ❑ FHA/VA: Yes ❑ No Q-- 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-----------------Distance from foundation---.----------------Material--------------------------.----------.----------- r—)(U7 T _- -_-__.rXUT tf4 No. of compartments--------------------------Size---------------•---------------Liquid depth_--- --------- ---------Capacity..... ---------------- Disposal Field: Distance from nearest well----5-0----Distance from foundation...-A)----------Distance to nearest lot line--- I:X�TiN C' Number of lines_.__________1_ -_-_.-.Length of each line___��_.__-_--. _._.Width of trench-.___rly____ ________________ iv'F P' Type of filter material---- _�K___Depth of filter material----.-1r------_--Total length---------------77 5—.___.--__-_____.- Seepage Pit: Distance to nearest well----1r0--_--Distance from foundation------/......Distance to nearest lot line------1- --❑ Number of pits_.--- _._.-__._._Lining material -.-.-.Size: Diamet r-__..__ _-_-:-_ Depth-.--7`LP-------- _/ , X Cesspool: 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):------------------------------------------------------------------------------------------------ }= .41 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------:- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- - �. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County_ ordinances, S fe laws, aq rules anregulations of the San Joaquin Local Health District. (Signed)------- `-a------ --- - -M --------------------------------------------------- - - -- (Owner and/or Contractor) By:------------------------------------------------------------------ ----------------------- ---------------------------------------(Ti+le) ------------------- ---------- --- -- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ►- -`-Q------------------------- -------------------------- DATE--------3- . REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------- ---------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------- -------------- -------------------------------------------------------------•-----------•----------------------------------------------------------- ----------------- ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------_ ---------------------- ---------------------------------- ------------------ -------------------- ----------------------------------------------------------------- -------------------_----------- FINAL INSPEC -------- Date-------- ( - s--�l----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 C.