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FOR OFFICE USE: t. _ ,:it�' -------- _.-_ .. - ------------------- --------- ------ - - - Permit No. ��'------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate} --------- - Date Issued = --------------------- - ------- --------- ---------------------.------- This Permit Ex fres 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 co pIi nce with County Ordinance No. 549. ---}--- w ---- /' p �- a F.�. ---------------•--------MT `------ JOB ADDRESS AND LO ATI N"""""�-�-N___._ 1 1- _ Owner's Name----------------�.6[4_&-----------MARK"----------------------------- ------------------ -------------- -------- Phone------------------------------------ Address--------------• -------A.QF ------------- ----------------------------------------- Contractor's Name---0-W-1V m----------- -------- -- ----- Phone. ------------------------------------- - - - Installation will serve: Residence ❑ Apartment House ❑ Commercial 4 Trailer Court ❑ Motel ❑ Other ❑ OFge.� Number of living units: t.---- Number of bedrooms ---- Number of baths _-_ Lot size -"./M--"rK-10q-------------------------- Water --•-- -•------"----- -Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- 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 ❑ No �HA/VA: Yes ❑ No F-fr- TYPE OF INSTALLATION AND SPECIFICATIONS: J(No septic tank or cesspool permitted if public sewer islavailable within 200 Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material Rte'% No. of compartments_-_--.----_ - Liquid depth-----_---.-_-------------Capacity Disposal Field: Distance from nearest well._-„S-70.....Distance from foundation..-"10"""""-.--Distance to nearest lot line---- ti -10-4& NG Number of linesf ----------------Length of each line-----_.z ----.-r----- Width of trench-------.2 .-- --------- m " ��C�-.."_Depth of filter material------ length"""-"___-"""�--------------Type of filter material A. --�� Seepage Pit: Distance to nearest well-----------------_--"Distance from foundation---.----------------Distance to nearest lot line-_-_.." ❑ Number of pits- - -----------------Lining material-----------------------Size: Diameter.---------------- -- Depth------------------------------- 11 Size: Diameter-------------------------- - --.Dept h------------------------------------------------.-.Liquid Capacity-------------------------- -gal Cesspool: Distance from nearest well----------------"Distance from foundation....___.----------..Linin material---.------._------__.----.-----_ ❑ ,� Privy: Distance from nearest well"-__.-.-_""-_--------------------------.-------_Distance from nearest building-----__-___-___"___-."""" -"...-_.~ Distance to nearest lot line----------------- ---- ---------------------------------- - Remodeling and/or repairing describe ppJ�t-- Sx�}T� >l'"ICS V` -"----' I g P g !� ' ---------------------------------------------------------- l. ") t _t� I l --------- -------------- --------------------------------- ----------------- --------------- ------------------------------------ ---------------- ----------------- - ;- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counl� ordinanceW_Sfat laws, a d rules and regulations of the San Joaquin Local Health District. R I,_ (Signed} -- ------------------- -----------------------------------------------{Owner and/or Con#ractorj., ---- ------ ----- ------------------------------------------------- -----=------=---------=---'-----=` R�= = --------------------- ` (Tiele} ace on �: .-.. - ... 7 (Plot plan, showing size of lot, location of system in relation to wells, buildings, e b placed reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- a ---------- DATE----------5 -r------------------ I REVIEWEDBY-------- ---------------- DATE---------------------------------------------- BUILDING PERMIT ISSUED-------- -------------------- --------------- DATE._--------------------------------------------------------- Alterationsand/or recommendations:------- --------------- ----------------------------"-------------------------------------------------------------------------------- ---------------------- I ------------------------------------------------------------------------- Date---- -- ------------ ---------------------- FINAL INSPEG SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1 Stockton,California Lodi,California Manteca,California Tracy,California F.R CO.