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r-UKUI-MCE USE: ------ ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -----------•------------------------------------------ (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 permittoconstruct and install the work herein descrl ed. This application is made in compliance with County Ordinance No. 549. 5 f� JOB ADDRESS AND LOCATION_.. --- 0 Da f�� /JT �P 1r� ------------- -------------- -- Owner's Name---------- C- Address -------- Phone Address- r� y----- Contractor's .. `? Q :............ Contractor's Name-ly+_---AQ_lghH-- h----Sal /_�<.------..SF7.F vj_ z .... Phone.............. Installation will serve: Residence Apartment House ❑ •:Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1----- Number of bedrooms _.. Number of baths 45;Lo! size --- �AE_f.�•r_F.................... I Water Supply: Public system *0. ft. Q E] Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ ' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay Adobe ❑ Hardpan Previous Application Made: (if yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No t 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_________________Distance from foundation--------------------Material................................................. r—XICS-P NIC-5 No. of compartments Size-------------------. Liquid,depth ----------------------Capacity....................... Disposal Field: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line............ . r—p1j)STI AJ(;,– Number of lines------------------------------------Length of each line------------------:;_K_-:_-...Width of french--------__-----_-------.-.__-.... Type of filter material.,--t----------------Depth of filter material...-•--------------_---Total length.......................................... Seepage Pit: Distance to nearest well----f02--------Distance from foundation_-. O........ istance to nearest lot line__.-.?...... �I Number of pits------/------------Lining material_RQC:_K_ ...Size: Diameter__— a Depth---- ________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.________-__________._........._.` ❑ Size: Diameter--------------------- ----------------Depth-------•-------------------------------------------Liquid Capacity-----------................gal Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__________---__________-------...._.-.... ❑ Distance to nearest lot rlin e----------------•--•----•---------- Remodefn9 and/or repairing (describe)-------------------- r� « •------------•-----•-•-•-- ----- ------ ----------F1_T...._15.-----lAr-----.SA1>----------0f�•------- - --------------------------------- -- - ------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin.County ordinances, State laws, and rules and re tions of the San Joaquin Local Health District. (Signed) ----------------- --- -------- �' {i� ----------------------------------------•---------------------._.(Owner and/or Contractor) By: ' --.(rtle} •-------------- (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--------- -' --'-Q----- ----------------- ---------------------------------------- DATE------ -----•---------------•--- REVIEWEDBY--•---------------------------------------------------------------------------- ----••--------------------------------------- DATE---------------------------------- BUILDINGPERMIT ISSUED_-------------------------------------------------------------------------------------------------- DATE_.-.----•---------------------••----•-------------------..... ' Alterations and/or recommendations: ------------ - ---------------------....-••---•-•---.••-•-•-••.•. -------•......---- N�------------------------------------------------- ...... . ....-�-�----.-��.-�+�— •1�.;..-�-!��-> T T f��©...... -- ------------ ,,-•�---------- CYT__..f/eF,� +' Ari7.(_I t 73 C.1----- �30� �f�. �'_�.._ -. . l_ _c W4 --- ��`Cam-------p�-L------!!U.._..._:a_" /V r--.= ---- ----- -- -•---- --- ---------------------------------------.-------------------------------------------- ---•- 1T ` FINAL INSPECTI� L Date------ /..-..: . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American&et 00 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,Ca f n , I � Lodi,California Manteca,California Tracy,California "� 1 11k E8 9 REVISED 0•59 2M a- AL 8