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SE--- FOR OFFICE USE- ------------------------------------- ----------------- ---------------- -------------------- ----------------------------------- APPLICATION 'FOR SANITATION PERMIT Permit No. ./... ----- ----------------------- ----------- - (Complete in Duplicate) ___________________-------------------.._._...__.___-.__. This Permit Expires I 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 com lien with County Ordinance No. 544. CA Lo IV � W-��_a _`�_._.._.S.00 - ------� E JOB ADDRESS AND LOCAT] P C'SMP-CL--------------------------------- Owner's Name-------------- L56A Phone---------------------- f Address------------------ �T --------- ' "- CIQ LC?/ k ----------------- ------------------------ ` Contractor's Name---Q_lAf1ST.J_=-N---- -------------• `"�pP Phone---------------•------------- -------------- ---------- ------� --------------- ------ Installation will serve: Residence VrAparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units: __1_____ Number-of bedrooms umber of baths ___t---- Lot size _._.l' Cp rF__A_6, ___________________ I Water Supply: Public system Community system Rrivate,Q`Depth to Water Table Oft. - I Character of soil to a depth of 3 feet: Sand ravel []w Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,idate_..__..__-,__..____l .No �' New Construction: Yes E] No �HA/VA: Yes [D ! No [R—'- TYP.E,OF INSTALLATION AND SP.ECIFICATIONS:.-... (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------ ------------- _-------------.-------____. F_X�T-/AfC-- No. of compartments--------------------------Size------------------------- "'° Liquid depth---------------- --------Capacity---------- ------------ _ Disposal Field: Distance from nearest well_________________Distance from foundation-------_------------Distance to nearest lot line,________________ ^(G. Number of lines------------------------ ----------Length of each fine-----------------------------.Width of french------------------__.._....____--- Type of filter material___-_------_-----_-----Depth of filter material-------------_---.--.-Total length---__...______.___________________.__.___- Seepag it: Distance to nearest well-5fl�'�-Distance from:foundation___�ra_--------Distance to nearest lot line_________________ , Number of pits_____ ---------------Lining material' Q Yom-.__size: Diameter_--- . _.__Depth...._$1X_9_.?X_------. Il Cesspool: Distance from nearest well-----------------Distance from foundation-----------------...Lining material---- -------------------_____------- . ❑ Size: Diarre !� '� te� . ------- -- - - Depth--------- -------------- I------ -------------------Liquid Capacity----------------------------gals. Priv 'Distace from Bare t well --------------- _Distance from nearest building ❑ ------------------W----------- Distance to nearest lot Ione_-,---=�-------------- ----- - '---------=�------------------------------------------ -- Remodeling and/or repairing (describe):------?I7"____ —p-tr—-----?Aa::R 1A__T_1--•--WR-5---------------- ----------------------------------------------------------------------------- - .1� e R—r4� ------I------------ ----------------------------------------------- I -------------------------------------------------------- ! ----------------I-----------------:---- ------------------------- --------------- \ ---- ------------------------------------------ ------ -----------------11-------------------------------------------------I-------------------------------------------------------------------- I hereby certify that I have prepared this. application and that the work will be done"in accordance with San Joaquin County s ordinances. State ws, and rules Id regulations of the Sari Joaquin Local Health District. - _ tib-ttv_______._._. Owner and/or ) (Signed } ��`' = -------------- ------- ( / r Contract or X13 .._.- - . ... . ----------------------------------------Tit e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----r A_.R___-------------------------------------------------------------------- DATE--------- s ---------------- REVIEWEDBY-------------------------------------------- -------------- ----------------------------------- DATE----------------------------- ------------------------------ BUILDING PERMIT ISSUED----- ------------------------------------------ ------------------------------------------- DA•TE--------------------------------- ----------- Alterations'and/or I•ecommeridations: - I N�ApF4" --------------------------------- ---------------------------------------------- ------------------------•---•--------------------- ----------------------•-•-- ---------- --------- ------------------------------ ----------- -------- --------------- ' - ------- ----------------------------------------------------- ------------------------------------------- ------------------------------------ --------- -........ --- - i ., FINAL INSPECTi B . --- -• --- ------ ------------- Date-- - -------- /-_ -7 --- -- -_-` ------------------- ----------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California.. Manteca,California Tracy,California i F.P.CC. - - � f