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FOR OTICE 0SE: -- z _-------_-_--_-----_ -_---_----_-_-___--_----.-. APPLICATION FOR SANITATION PERMIT Permit No. _. �' �...... ' _._ _ t __________ -- (Complete in Duplicate) 1 •-- -- Date Issued _ /0S____ This Permit Expires 1 Year From Date Issued Applicatio ruby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application iisade in compliance with County Ordinance No. 549. M`1'C�G. DI= A 1JOB ADDRESS D L CATION.- U.�"-a"�_f.11.-----1� ''mss Owner's Name----------- - '--�------IBRVC_K:F�X---------------8-Te_-� --.BOx 25. f �"e----------- Address----------- Z(�OQ......... P 1--F1-C`----444---------- '----------------------------------------------------------- ----•-------------••------ T _R /W_cP!wA b------5_'T T is = Phone. Contractor's Name___ ..�__ .t __ ---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ElNumber of living units: ---I--- Number of 4rooms3_. Number of baths 2-- Lot size --- ---- ----->/_t- --------------------- Water Supply: Public system ❑ Community system ❑ Private 21 Depth to Water Table /(1_ ft. Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑. Hardpan ❑ Previous Application Made: (If yes,date--------------------) No � New Construction: Yes 2+—No ❑ FHA/VA: Yes pq] 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____S- -----Distance from foundation-----/ ---------Mrial---- CRR_T_�:__.---__. 2111— No. of compartments_.___ -------------Size.s.x__'57—-------:...Liquid depth__ - ""--"---------Capacity../$-,0___ Z Disposal Field: Distance from nearest well.-.5_P___-Distance from foundationfff—----- istance to nearest lot linpr___.�.—---- — '' Number of lines-----------2-------_-----------Length of each line--- �_'-!}_.�___ ._.Width of trench------- -------,----------- n �^ 1g Type of filter material __� _�-K___Depth of filter material___ __ ______ _____Total length_________.._._�-___d___._._________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------- .........Distance to nearest lot line-_.-_.-.---..._._ ❑ Number of pits----------------------Lining 'material-----------------------Size: ter-----------------------Depth-----.-----.----------------_.--- Cesspool: Distance from nearest well--.--------------Distance from foundationV) --------------Lining material-----------------------•-------•----- _1 ❑ Size: Diameter------------------------------- ----Depth----------------------------- ------Liquid Capacity------=-------------•------gals. r , Privy: Distance from nearest well ___--------------------------------------------Dist e from nearest building------------------------------------------ F71 _.___.____------- ----- --------❑ Distance to neare t lot line-------------------------- -------- ---------------------------------- --------------------------------------------------------------- Remodeling and/or repairing (des ribe�__/��'..(p_ ____.__ ____________G .I'J�►_V_4,- -�-----•-- -- , �-t`�I- ---1-------------- - ------------------------------- - ----------------------icl- G�x"1'1 ---------- --------:: l 'N -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and lations of the Ian Joaquin Local Health District. (Signed)-------I-- -- -------- ------0-- . ---- -- - -- ---------------------- -- (Owner and/or Contractor) By:----------------------------------------------------------------------- ------------------------------------------------------------(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------ = - ---------------------------------- DATE--3' Z$-' ------------------------ REVIEWEDBY----- -------------------------------------- ------------------------------- ------ DATE-------------------------------------------------••-•------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------- -------------------.-..------- ----------------------------------••------------------------------------ ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------=---------------------------------------------..------------------------------- ----------------------------------------------- --------- ------------------------------------------------------- ----------------------------------------------------- --------------------- ------- --------------------------------------- ------- ----------------- -------- -------------------------------------------------------------------------------------------------------------------- -------------------- -- -- -------- --------------------- -------------- - ---------------------------------------------- ------ ------------------------------- ----------- ------------------- FINAL INSPECTION BY----------------------- --------- t -------------------- Date--_----------------- ---------------------- SAN . -------- ----- SAN J.OAQUIN 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.C C. t �