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FOR'OFFICE USE: ------------------1 ---- ---------------------------- "APPLICATION -- -------- ----- APPLICATION FOR SANITATION PERM IT � �`1 Permit No. .- -------------- ------- { - / _��-l_- _ (Complete-in Duplicate) Date Issued __________ _____ ---------I-__-_._--_____._.__ 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 Count Or ina ce Pa. 549. JOB ADDRESS AND LOCATIOI,V a _-�STJ R—D----------1 ------ 0 N / /fin r3WN�� Owner's Name. ''�'1-- -� -/1� I-'!L l� 1.�`� .- M-i-L' (1j ------`----- a4-Phone-------------- --------------------- Address-------------- 1_7 -------t9k?T-I--N....... M Contractor's Name------Fv L_LIcTk----------------- ----------------------------------------- ----------------------------------------------- Phone.......---------------------------- Installation will serve: Residence ❑ Apartment House❑.,,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A____ Number of bedrooms3i-''1 Number of baths Z Lot size __��?�V_Q.t�___Q.____-�-___________________ Water Supply: Public system E] Community system [IPrivate (Depth to Water Table 14?/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 Ej' New Construction: Yes gr`f�'o ❑ FHA/VA: Yes R—_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-_51P-----Distance from foundation----- -.--___..Material ---C_C1_N C B ZT_�__-A__. 2K No. of compartments__.__-�--_.-.-__-Size__�XI.p---X_' Liquid depth_-_f�2_________ 49 Capacity./Zon ____ Disposal ield: Distance from nearest well__.5_0_.---Distance from foundation-----/:Q _-Distance to nearest lot line...... Number of lines.._.______ ____Length of each line___----�.5A_7SWidth of trench-______.2`�_''.___________ � Type of filter material__ . O-C_) __Depth of filter material------1. _."-___._Total length---. ------- ----------- Seepage _Seepage Pit: Distance to nearest well--------------_-------Distance from foundation-------------_------Distance to nearest lot line--___.-_-----__-- ❑ Number of pits---------------------Lining material---------------------- Size: Diameter__________________.....Dept h-----------------------.-_-_____- C Cesspool: Distance from nearest well ________________Distance from foundation_-------------- _.Lining material_.----.----------------------_....... T ❑ Size: Diameter- -- --------- ----- - --------------Depth-------- ------ ------------------------------------Liquid Capacity----------------------------gals. .`. Priv Distance from nearest well-_..---------- -------------------- -------------Distance from nearest building - ❑ Distance to nearest lot line ----------------------------------------------------------- -------------------------------------------------------------------- Remodeling and/or repairing (describe):___SY.�TFM------�-4T----- �� N_ �----_.�f -----O- -�-----�lr--17.r___---------- -------------------------------------a!_RI3_ GF_.----t�R1 rV.I? ---------,R "' -------------- ---------/$_ Q----��----t---fir - ------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- ---------------------------- ------------ -----------(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 'Tr- = ---- ---------- ----------------- ------------------- DATE--------- '^ REVIEWED BY------- ----------------------------------------- ----------__---------------------------- - DATE------ ----------------- ----------------------------------- BUILDINGPERMIT ISSUED-------- -- ------------------- ------------------------------__----------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------- ----- -- ------------------------ ----------- --------------------- -------------------------------------------------------- --------------- ------------------------------------ ------------------------------------------------------------------------------------------------------ --- --- ----------------- ---------------------------------- ----------------------------------------------------------------- --------------------------------------------- ---------------------------------•- - ----------------------- ----- --------------- - - ---------------- ...--- --- --- ------ - ----- ------ ---------------------------- NFINAL INSP BY: - �G� 2 Date----- -...77. 7_--- ------ 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 E.H.9 2M 1.67 Vanguard Press