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FO-*OFFICE USE: / APPLICATION FOR SANITATION PERMIT Permit No. r. ....... -- ------- ---------------------------- 2 ---------- _'} ------------------ (Complete in Duplicate) 7/k./l/6 S 0 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 hereirv.described. This application is mad in compliance with County Ordinance No. 549. / /TC/c} sI �E / ADDRESS AND LOCATIO .--------- - (1ST7-�V -,�.-��------ IV----- n .....I Z-�?----------------- JOB Owner's Name--------------• ----------- _LT(4')_f} ----- - ----- - ------ hone Address.....................L_)_T! l-- ...T30X------1-3. ----C-----------• -------------------------------- Contractor's Name------ ..-_____ ____ Phone--------------- t Installation will serve: Residence [�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units . ___ Number of bedrooms 3---- Number of baths I--- Lot size /?- -A�R F ---------------------- Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table ._ 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 New Construction: Yes ❑ No 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: Distance from nearest well-----------------Distance from foundation--------------------Material--------------- .-_.----_--_-__.___-_.____. C EXE$T r4,i*- No. of compartments------------------------Size--------------------------------Liquid depth----------- ------Capacity-•••-------•. G Disposal Field: Distance from nearest well---.--5 _-._Distance from foundation___10-----__.Distance to nearest lot line.--- ...... V► Number of lines---------- ------------------Length of each line-------S-5--------�--____.Width of trench-_-_-. _ _--�-------.__.._ -1- +�+Dn Type of filter material-52--- - RQC Depth of filter material-__.-_J_�_- _ ----___Total length__ _:-__--_-_�a------------------ Seepage Pit: Distance to nearest well----------------___---Distance from foundation-------.............Distance to nearest lot line----------------- y, ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.-----------_----------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.-_-_-------------------_._------. 3 ❑ Size: Diameter------------------------------- ------Depth----------------- ---------------------------------_Liquid Capacity----------------------------gals. 10, Privy: Distance from nearest well -___.__-__ -----------------------------------Distance from nearest building---------_.------------------------------- 70, ❑ Distance to nearest lot line------------------------------------- -------------------•------•-•--------•----------------- -------------------- -------------- ---------- Remodelingand/or repairing (describe):---------- --------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------------------------------------------------ ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule nd regulations of t e San Joaquin Local Health District. (Signed)_ • l-; 2 --------------- ----- ----- ------- - - (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 APPLICATIONACCEPTED BY----------- --------------------------------------------------------- DATE-------V_79-5------�------------------------ REVIEWEDBY--------------------------------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations------------------------------ ------ ----- -- --- --------------------------------•------ -------------------- ----------------- -- -------------------------------•-----------------------------•-------------- ------------------------------- ---------------•----------•-----•-----------`-•------------------------•-----j-------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------- -- -----•---------- ------•----- ---------------•--------- ---- ------ ---------------- ----•--------- -------------------------------------------------------------------------- -- • ----- ------------------- FINAL ------------------�;..._. FWAL INSPECTI BY iyf � ----- 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. -