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FUR"OFFICE'USE: --------------------------------- ' ----------------------- ------- .------- ... APPLICATION FOR SANITATION PERMIT Permit No. .15L/ ---------------------------- ------------- -- ------- (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 compliance with County Ordinance No. 549. �ZS O 20 ,,,r.4 A4'T-rA JOB ADDRESSA D LOCATION_-_ � _ Q11� ` �f °d Sd¢' C7 Owner's Name--- OAA/ J / '�•�� -------------------------- ------- --------------------- ----------- -- Phone------ Address----- -----Address----------- -------/ t _ r - - Ph Contractor's Name-------- P ' � } f = one. , ---------------------------------------------- Installation will serve: Residence Apartment use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _ Other ❑ Number of living units: _J--- Number of bedrooms -?.- Number of baths _/____ Lot size --------- ± -1I<f${ -- ------------------ Water Supply: Public system ❑ Community system ElPrivate° ' 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,._.-,._-:--- ----) No 9 New Construction: Yes ❑ No ❑_ FHA/VA Yes ❑ No EA 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____ D--- Distance from foundation--- Ma erial_____- No. of compartments------------�__.------Size_*T'Y-C_Y-1 _Liquid dei?th--._. ..6_`.-_-Capacity____-- -----_-_--I i Disposal Field: Distance from nearest well--6 -----Distance from foundation_____/P-------Distance to nearest lot line-.---6 h Number of lines________________ Length of each line_----____ - -- g 1$1 x-----.Width of trench ----'- -'--- ---s�-------------1 YI3 p ---.Total length------ -� ' • 1 Type of filter mafierial4�_ __- De th of filter material_._.__ _____ I --------- Seepage Pit: Distance to nearest weft-----------_----------Distance from foundation------------------- Distance to nearest lot line-----.________----- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------------------- Depth-------------------------_.- Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material----------------------------------- ElSize:j` Diameter---------------------------------- ---Depth----------------------------------------- ----------Liquid Capacity------------ ---------gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------_-- ❑ Distance to nearest lot fine Remodeling and/or repairing (describe):---R6w,,.t1_Q_a/ ------------------------------------ ----------------- ------------------------------- - - -.-__-.-.-- ------------------------------ --------- ----------- --------'-- --{., .l I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa--uin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. el. (Signed) ` > - - �Cd - (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_.�=a19_,©-'-------------------------------------- ----------------------------- DATE---- .E1.-_ _ , REVIEWED BY------------------- -------------------------- ---- ----------------------------------------- -- -------------- DATE ------ - -- ----------------------------------------- BUILDING PERMIT ISSUED-- - -------=: DATE------------------------------- ----------------------------- Alterations and/or recommendations:------------------------- - --------------------------------- ----------------------- ----------------- ------------=------------- ----------------------------------------------- ---- ----- ---------- ---------- ------------------. ----------- ------------------------------------ -- - ------- ------------------------------------------------- ----------------------•--------- ------ ----------------------- ----------------------------- FINAL INSPE ---- - Date--- ----------- 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