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FOR OFFICE USE: - __.--_______f'.',� APPLICATION FOR SANITATION PERMIT Permit No. <...�-a�.Z_ ----------------- ------------------------------------ (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. JOB ADDRESS AND LOCATION... p---�C}.__-___ a+BERT-----------------_------ Owner's Name-- ElEiNEW-------paj RS------------------------------------------------- ---- --------------------------------------- Phone------------------------------------ Address--------------------------------------------------------%854------ ,... -4t4r-------4V-e* -------------------------....---------------------------------------------------------------- Contractor's Name-.--------Barj#i>iii-------pow-FEZa---------------------------------------------------------------------------------------- Phone463.3.2.09----.- Installation will serve: Residence :R] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.-1-- Number of bedrooms ---2-- Number of baths _1..... Lot size ----?ZX1.23_______________________________________ Water Supply: Public system f] Community system ❑ Private ❑ Depth to Water Table ---50 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No:j] New Construction: Yes E0 No ❑ FHA/VA: Yes ❑ No 58 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__50f't._Distance from foundation__- Q_f+_'r.o__.Material----Conerat_.-__-_-_--._-.._--_-_. X] No. of compartments-----2------------ -----Size-----5X-5x.10._.-_:-..Liquid depth_ '�-4f ,---._.--__-_Capacity.-W-0_-_____ Disposal Field: Distance from nearest well_ tDistance from foundation-_1©f !._-Distance to nearest lot line_--ft ----- Ek Number of lines_.--_-I--_-.--__----------------Length of each line----90f't-------------Width of trench..2f't----_----.---_----_--. Type of of material-RAL'k------------Depth of filter material _-1.a:2IIa------Total length------9-Q.f'_t:-______________________ Seepage Pit: Distance to nearest well----100-ftl—Distance from foundation___1,Q�_ __.Distance to nearest lot line__5: t,__._ Ede Number of pits------.---1.--------Lining material------Rook-_-Size: Diameter._33iM*-.--.__Depth----_25ft e-_-._-----.- Cesspool: Distance from nearest well--- stance from foundation-',%41W--.Lining material-------------------------------_-._. ❑ Size: Diameter----------------- -------------- ----Depth--------------------------- -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line---------------------------- ----------------------------------------- -------- ------------------------------------------------------------ Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------- ------ ----------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------ ------------ ----- ---- --- 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 and regulations of the San Joaquin Local Health District. (Signed) _ - ------------- Owner and/or Contractor) 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----------- ------------------------------------ --------------------------------------- DATE---`�-7 Z11--------------------- REVIEWEDBY-----------------------------------------------_- -------------------------------------------------------------------------- DATE------ ---------------------------------------------------- BUILDING PERMIT ISSUED-------------------------- ---- ------ ------ TE----- -- -- ------ ---- - - ------ --- --------- Alterations d/or recommendations:-------- ------------l 6 ' ` --------------- ------ - ----- flt �------- '--- r ------ - -----------------e4------- - --- - ---- -- --- - - -------- --- —-- ------ - -- -- -- ---------------------- - , a�-�� ------------- ---- ------ Q `.eo FINAL INSPECTION BY:.. - Date - ---- --------------------- ------------------------- SAN JOAQUIN LOCAL HEALTH-DISTRICT 1601 E.HazeNon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.