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FOR OrFICE USE: ' ___________________________________________._.._-___ APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- ------------------------------- (Complete in Duplicate) Date Issued ---- -----------------------------------------------------__._--_________________________________________ This Permit Expires 1 Year From 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. �� f VV s,D>En _ JOB ADDRESS AND/LOCATION______A_RP R---r_-__WA _____ ___ _ __ �.___pl___...__/V.VF_1_-njCF :--. Owner's Name----------/146N_.F 4"--•-.. ------------------------------------------------ ------------ Phone------------------------------------ Address ` - D ---------� x----.._- L Contractor's Name------r l l)(EK--------------------------------------------- ------------------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.t---- Number of bedrooms2- Number of baths -f----_ Lot size ---AGPjF- " =___-_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ff- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes Zr"'No ❑ FHA/VA: Yes ❑ No.2� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTank: Distance from nearest well _ Distar from foundation--___A2--.-_-Mate�al-__I_ .;�-9 0.2>.,_____...riCa acit _ )Og©-___No. of compartments_ .__ ________._cSize_ _ X. Liquid depth_.-� Disposal Field: Distance from nearest well---t-0-----Distance from foundation....�._ Distance to nearest lot line ------------- -3 h ®� Number of lines__________________________________Length of each line-------7 '---i-C-_-_.Width of trench._.__-_ �c ___._(_.--_------ Type of filter materia__ Q_t�} :.Depth of filter material-----'_______.---Total length-------------- —---------------- Y Seepage Pit: Distance to nearest well_____________ -----------------------Distance from foundation--------------------Distance to nearest lot line_____._________._ .� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----________________-_____�O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----._._____._____________________ IJ Size: Diameter---------------------------------------De th---------.------.-------.__.---------------------__Liquid Capacity gals. .......... Privy: Distance from nearest weli,3 ,,------------------------------------Distance from nearest building------------------------------------------ 171 _____ _-_-..-_-_-----_-_ _______- ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------ - Remodelingand/or repairing (describe):--------- ------------------------------ -----••-------•--------------------------------------------------------•----------------------•-- ........... ---------------------------------------------------------------------------------------------------------•--------------------------------------- -------------------- ------------------•--------------------------------- ---------------------- -----------------------------------------------•----•------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- -•------------- --------------- ------------- I hereby certif t 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules and reulationsof th aquin Local Health District. (Signed)-- _______________________________________________Owner and/or Contractor - BY r ---- ----- -------- - ------7---------------------------------------------- -- -------(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---- --1--`_R 0------------------------ -- -------------------------------------._ DATE-----/ --1-- 96 C74 REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE-------- ------ -------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:----------------- ------------ -------------------------------------------- -------------------------------------------------------------------- __1----------------------------------- ------------------------------------------------------------------------------------ ------ ------ -__._._____________________________________________________---.-._--.-_____ -f__..__..-_.-_.___-__._.__.___-___-___-.__-_--.--_..-._--_- ------------------------------------------------------------------------------------- --------------------------- FINAL INSPECT! :. -, -- _ ^- -- Q-- ----- -- -- 1./--- - =--- -- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California