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FOR OFFICE USE: ` a� --------------------------------------- - APPLICATION FOR SANITATION PERMITPermit No. -----------------All ------------------- -- (Complete in Duplicate) *� 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 made in com.�iince with County Ordinance No. 549. ��PON U STr n(JOB ADDRESS AND LOpC-AST -..... liN-------- ------------------- R[7 �►- 1/� �i.1.PUnl-----RD---------------------------- Owner's Name------------/_�.ATS-!_F?_o_N----------- 5;------- -------- Address ............................ -5Li t...------ . —•-------R Contractor's Name__._.0.W_1V_fF__K--- - - -_--------------------------------------------------------•------------------------.- Phone................................... Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel Motel ❑ Other Number of living units: ----_-_ Number of bedrooms _ ---_ Number of baths j-___ Lot size -----AjCRE A_&.�____________________ 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 Mader (If yes,date---------- -------._) No ❑ 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-----------------Distance from foundation--------------------Material-------.--.---------------------------.-____----. SaRF-S P,I_ No. of compartments-------------------------Size-------------------------------Liquid depth---------- ---------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line...___-_-_..____- >Fa(1.fiT1AA& Number of lines_--------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-------------------....Total length------------------------------------------ Seepage Pit: Distance to nearest well----JQ_ -------Distance from foundation----/Q_........Distan to nearest lot line_S. APP Number of pits-----(---------------Lining material__(1G-Cl ____Size: Diameter--YA.- _-_Depth-----X771-- -_---.-_-.__ 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------------------------------------------------------------------------------------------------------Z----------------------------------- Remodeling and/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, �STT laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - �"*'�---------- ----`---- ---C -�-------- (Owner and/or Contractor) By-------------------------------------------------------------------------------------------------------------------------------------(Titte)------------------------------------- ------- --------------- (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___F.1R_`_0=-------------------------------------------------------------------- DATE--------,3e-------e2n%L_'14-------------------- REVIEWEDBY-------------------------------------------- --------------------------------------------------- --------------------------., DATE----------------------------- ------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE------------------------------- ` Alterations and/or recommendations:-------------- ---------------------------------------------------------------------------------------•••---------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- L L FINAL INSPE -- -- -- 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.