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FOR OFFICE USE: ..,- --------------------------------------------------------- / APPLICATION FOR SANITATION PERMIT. ✓ Permit No. ... S ______________________ ____ -� ------------------------ --------- - --' - (Complete m Duplicate) 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 compliant with County Ordinance No. 549. � o JOB ADDRESS AND LOCAAAT��rIO - .cm-°----r�u'-TL-N------' "_ Q �. , -------AV- ----------- �-4 Owner's Name-------------------�`_!�I-A CTER---------------A-0 -F-L L----------- -------------------- Phone------------------------------------ Address--------------------- T ._-- "-._ _Q ---------2.2:y-----------M.7— -------------------•-------------------------------••-•----------•--•----------- Contractor's Name-------0-LU/ F—: _ ---_-__.-- Phone................................... -- ---------------------------------------------------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: _/----- Number of bedrooms o Number of -aths _._�___ Lot size ___.��-,__��®___.__.__...�-________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ..9 ft. Character of soil to a depth of 3 feet: Sand W_-G-ravel ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (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 nk: Distance from nearest well----- -----Distanc from foundation_.-0-----------M er' i_-C-pNl A. T. .--____. No. of compartments..-- -__._.-__.Size___ Xi7QX__ __Liquid depth____ �.._-__-_Capacity____--�Q®_ Disposal Field: Distance from nearest well.--- ._--Distance from foundation---/.Q_____..Distance to nearest lot line---- ___..... [[ / Number of lines----------- Length of each line-- ------------------Width of trench-.---- .. .._.-_-._jj Type of filter mate ria I__F0.CK-_-Depth of filter material-----I_ - _ _<< Total length.._._.._` `____,/_Zd. Seepage Pit: Distance to nearest well.---------------------Distance from foundation--------------------Distance to nearest lot line-_-_-__-.___-_--- S ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --------Depth--.------------------------------ V? Cesspool: Distance from nearest well-----------------Distance from foundation-____--. Lining material_..-.._--_-.-.--.-.--_----_--_-_--.- .� ❑ Size: Diameter-------------------- ----------------Depth_---- -------------------------_-------------Liquid Capacity----------------------------gals. .7 Privy: Distance from nearest well--------------------------_---------------------Distance from nearest-building._-__________________________________--. ❑ Distance to nearest lot line --------------------------------------------------•------------------------I--------------------------------------------------- Remodeling and/or repairing (clescribe):_------------------- ---------- ----------------------------- -----•-----------. --•-----------------..-..-•---------------------------•-------- O -------------------•-----------•-•-----••------------•-•--------------------------------------------•-----•---•---•-------------------------------------------------------------------•--------------------------------------- ---------------------------- ---------------- --------••----------------------------------------------------------------------------------•_---------•_------------------------•---------- -------- ----------------------•-------------------------------- ----- 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 laws, and rules and regulations of the San Joaquin Local Health District. p (Signed)_Ov -- - lfle�_A_.--------------------------------------------------___-----------------------------------------(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---- 71R _-------- ---------------------------------------- DATE------- 1- 6b-- ------ REVIEWEDBY------------------------------------------------------- ------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------------------- ------------------------------------- -- -- ---- - - - --- --------- --- ---- ---- ------------------------------------------------------- -------------------------------------------------------------- ---------------- --- --- -- - ----------- ----,-/-- ------------------------------------------- -------------- _--- V' FINAL INSPEC -------- Date.------ --- -------- -- -2 — SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.