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FOP,OFP.CE USE: - w - --------------------- ______-__.--_-._---.-___----. APPLICATION FOR SANITATION PERMIT Permit No. ..�7� �1..... --------.Y £ ------ (Complete in Duplicate){ p P /3?O� w' OS_Ed'-t r-T� Date Issued --- ---- ---- ---- __- ... �_, . . ._ . This Perini} Expires 1 Year From Date lssut3d 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 County Ordinance No. 549. / 20— l q0 ,L 9 pp _ /�'`-'J ------.z �----------46 --------- ---- ._ " .JOB ADDRESS AND LO ATlON..___�-_��__�-._-- -T � CJ1."------- -- --1��-r��-K--1----: ' Owner's Name----- ------- --------- -- '�•�:------6-T-Q_�--- ------------------------------------------------- -------- ------ Phone-------------------------------- Address ----------------------------- Contractor's Name__!`L -AR&1t.L.0;1-----------=---------------- -----------------------------------------------------•----- ------ Phone-------------- will serve: Residence Apartment House:❑ Commercial ❑ Trailer Court ❑ Motel ❑ Othelr'❑ Number of living units: _r-__._ Number of bedrooms_^-_ Number of baths __I____ Lot size ___^ C }�_ _ _______________________ Water Supply: Public system E] Community system E] 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---------------_---I No � New Construction: Yes No ❑ FHA/VA: Yes ❑ No�' TYPE rOF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 --- nQ _�` stance from foundation__.-�-r:_._.___..Material---------- ____________________________ _ p� Septic rJ6 Not of compartments---well_---------- --Size-----.---- --- ---_Liquid depth--------?=-----------Capacity------�--------- Disposal Field: Distance'from nearest well.__.�._0.....Distance„from foundation.__ Q________.Distance to nearest lot line___��1.__. E.XL[fS T 1 AJG- Number of lines=._____. - ----------- ----Length-of,ea lineS- •-`P___--�� _- Width} of trench.-.---_�y-�---Q-.---------_-- � � .�d Type of filter material___ �_�_ ..__DePth ofematerial_ _�_____'___TotaI 'length---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation ..- _ .Dist nte to nearest lot line----------------- .< ❑ Number of pits----------------------Lining material----.----------`__!°'Size: Diameter-__--�--_-_---Depth------------------------------- J, Cesspool: Distance from nearest well-----------------Distance from fo ndation...._--__�.--.- Lining material_____._.__.__..__________.__ ___ } ❑ Size: Diameter-------------------------------- ---'Depth---------------------------- - ------------ -------.Liquid Capacity- - ---------------------•--gals: Privy: Distance from nearest well----_---------------------------.__.______._.._Dist nce from nearest building_.._______._._.____________________---- Distance to nearest lot line - ---------- - =� Remodeling and/or repairing (describe)------------------------ ----------------------------------------------------------_----- ------------------------ - -----------------------•------•--------------- -_----•--------------------•------------------•---------•-------- -------------------------•------ --------------------------- ----:1 i. -----------------------•----------------- -------------------------------------------, ----_--------------------------------_______.__________________-______________________._________________-__________________________-_________________-______--_______-_-_-_-_____f-_.--------------------------------.J 1 hereby certify that I have prepared this application and that the work will be done in accordance with San-Joaquin Counfy-a j , ordinances, State laws, and rules nd regulations of the San Joaquin Local Health District. t {Signed) ,ice -----------------------------`� (Owner and/or Contractor,) -------- - ---------------- By:--------- ------- --------------------------------------------------------=------ J-{Title) -•----=--------- ----------- ----....._._...------- (Plot plan, showing size of lot, location of system in relation to wells, buildingOetc.,tcanrbe.placed on,reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------T-1-R 42-.-.---.---.--__-______________ ----r----------------------------- DATE--------- 7�� ---------------------- REVIEWED BY----------------------•----------------------------------------------------------- ----------------------------------------- DATE-------- -- ---------- •-------------------------------- BUILDING -------------BUILDING PERMIT ISSUED---- --•---------------------------------------------------------- ------ DATE---------------------------------------------------_--------- Alterations and/or recommendations-------------------------------------------- - ' t: a s , ----------------------------•---------------••------------------------------------- --------------------------------------------------------•-----•----------- -----•--- ---• ..................................... -------------------- ------------------.................................. -------- -- -------------- -- ------ ---- ------- FINAL INSPECTI, BY Date.- ---------- ------------- =--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 1.