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rUK Ut+1CF,USE: ----------------------------- - ------ ------ APPLICATION FOR SANITATION PERMIT Permit NNo.� `� _ (Complete in Duplicate) . ------ ----- ------ ---- ------ This Permit Ex fres 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 comp nce with County Ordinance No. 549. E . 5 �J JOB ADDRESS AND LOCA O�l�DE �N -�------------- ---------------- _5 &-/ -ETI Owner's Name ---- ------------------ ----------------- ----------- =-----------------. Phone------------------- T r Address-------------- - -�---'---�-`----�OX-----------1-37 5--------E-51;�19 Ln_(Q-•---------••-------------------•- Contractor's Name---- W --------------------------------------------------------- ' ----- -------------------------------- -------------- Phone---------•--------• ••--•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ Number of living units: _-#--_ Number of bedrooms 3_-.- Number of.baths 1------ Lot size _._R_C - j�}[R ___ Water Supply:pp Y: Publicsystem ❑ Community system ❑ Private 0-'Depth to Water Table _74_ ft. Character of soil to a depthof an [❑ Gravel ❑ Sandy Loam ❑ Clay Loam�Cla y (:1 Adobe El Hardpan rf 3•ftSand ❑� # Previous Application Made: (If yes date_._..____ _.._.__) No �ew Construction: Yes ❑ No SHA/VA: Yes E] No I-_ TYPE OF, INSTALLATION-AND. SPEC.IFICATIONS:� (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) } Septic Tank: Distance from nearest well______ Distance from foundation--------------------Material...--__-_--._-_ - �57TI ACC— No. of compartments--------------------------Size--- ----- ---Liquid depth-- ----------------- - Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------- to nearest lot line----------------- E ISTI 14C Number of lines-----------------------------------Length of each line-___-__----1____ -- Width of trench ----------- ' p g e of filter material--- Depth of filter material----------------------Total length------------------------------------------ Seepage -----------•------•-------__ 1 TYP - See a e Pit: Distance to nearest well------ ------Distance from foundation___---LZO------- Distance to nearest lot line__._ -- '"0- Number of pits-_.--_/._-----------Lining material---AD.1C-K---Size: Diameter__&.�(__ ____ Depth..._��_--------------.--_ Cesspool: Distance from nearest wail---.------. _-_Distance from foundation___- -----------:Lining material-------------------------------------- Size,: Diameter........ ---- ----- _.-------Depth-------------------- -------- -------Liquid Capacity 9a Privy: Distance from nearest well-__----- ------------- --- ----------Distance from nearest building_._.___------.---_ ❑ Distance to nearest lot Line r: - ---------------------------------------------- Remodeling and/or repairing (describe):-------/-PPI TT(,dei --- -------- ------------------- - -- --------------�+-R-0----------------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------- ---------------------------- I hereby ter i y that f► a prepared-this application and that the-work will be done in accordance with San Joaquin County ordinances, Stat aw and is an re ulations of the SankJoaquin Local Health District. (Signed- w er ' -- - n d By. t K_ Title '••"•` o Contractor) tor) (Plot plan, showing size of It lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F .,, � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 7_t_ .V 0 ------------------------ ------ -------- REVIEWEDBY--------------------------------------------- ------------------- ------------ DATE - - - ---------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------------------- --------- DATE-------- ------ ------ Alterations and/or recommendations:._----------------------- ------------ - -__'- ------------------------------- ----------------------------------- ---- -------------------- --------------------x--------------------------------*---------------�_----------------------------------- 4 ---_------------------------- FINAL 1NSPIC Date--------- -1-.P- ( _.-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellion Ave. 300 West Oak Street r 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Trocy,California F.R CC.