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------__ - _ _ v APPLICATION FOR SANITATION PERMIT Permit No. ___1�6.3, ------------------------- --------------- (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued Date Issued _4/ Application is hereby made to the San Joa uin L al Health District for a permit to construct and install the work herein described. This applicationisinade in c pl, ncW rdinance No. 549. JOB ADDRESS A. N-D LOC. -_ �-- • -------- --------� ---------- - -------- � " Owner's Name---AN/1-< .� 0 J----------------- one --f'. ---------------------------Address-------- 7-S_ - ............................................. Contractor's Name----- ---- .i --------------------------------------------------------------------- •----•--------•------•--- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial Trailer Court OI Motel ❑`tither_..❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size =-. / � -,--- Water Supply: Public system ❑ Community system ❑ Private p�j epth to Water Tabl 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 [ff" New Construction: Yes 2 No ❑ FHA/VA: Yes ❑ No ®--' 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__/PO----.__Distance from foundation__/-.Z-----------Material----- No. of compartments-3__-__-____ 4'.•` -___.-_Size-__ 7'4'94kZO.Liquid depth-----,.S"_'___-_____-_.Capacity--__ Disposal Field: Distance from nearest well.lf'"U.'_._Distance from foundation_4.O-----------Distance to nearest lot line._________ [>J" Number of lines--_.-_%------___-.___--._____Length of each line____9a.--___________---Width of trench..?.4 '!___--.___..--• V/ Type of filter material_111C'_E`C-__S_____.De th of filter material___./ _ U ' - p �----�--------Total 10--- uJ W Seepage Pit: Distance to nearest well---/.I_Q---__-----Distance from foundation_1.0._i_-........Distance to nearest lot line---07.i.-._._ Number of pits---.__2------------Lining mate ria --- Diameter----2-_1(-. _Depth___.2_.S"__-__.________. Cesspool: Distance from nearest well-----------------Distance from foundation---------..---------Lining material-----.--------------_---------_._---- ❑ Size: Diameter------- ---------------------------._Depth------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ..__-______-____---.--_.------------------._Distance from nearest building-----.------------------------------------ V ❑ Distance to nearest lot line Remodeling and/or repairing (describe :-------------------- ---------------- ---------•-------------•------------------------•---------•-------- •--------------•--------------------------------------------•-------•------------------ ------------------------------------------------------------ - V --------------------------------------- ------------••--------------------------------------•------------------------------------------------------------------------------------------ --------------- I 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 nd regulations of the San Joaquin Local Health District. (Signed) ------------�----�------ ---------------------------------------------------------------------- --- ---------------------(«'�r Contractor) BY:---------------------- CRS ' Tttle -- - - - -------- - - - (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___.__ __._. __ _,.-____ DATE-_-___1_! i_ -______-_-_- - - - - ---------------------------------------- ---- REVIEWED BY ------------------------ -------------- DATE --------------------------------------------- -- --------- UILDING PERMIT ISSUED----------------------------------------------------------------------- ------. DATE------ ------------------- ---- Alterations and/or recommendations:__.---f0-_ie - -_ y ------------------------------------------------------------ __ fp l --------------- -------------------------------------------------------------------•--------------------------------------------------------------------------- ----------------- -------- -------------- --------------- ------ -- - FINAL INSPECTION BY:..._ - ` --,•---- Date--- - -- SAN JOAQUIN LOCAL HEALTH DISTRIC 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California