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FOR OFFICE USE: - - .-- _ __----- APPLICA!IO - N FOR SANITATION PERMIT Permit No. .,L 5!._.�D...S (Com(Complete in Du hcate P P ) Date Issued - --------------------_._-__.--___--------.__.-------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in,com liance with County Ordinance No. 549. 144, -A t JOB ADDR AND EJI A N R PC7 RT^ I CCC:-------- ------Q� /LjN. -----------I ZU---- /� nn — Owner's Name----------111 ___+_I_C_K5---•------ _�- 1 / _ _ .------------------ Phone-------------------•---•-------•---- Address............. Tr ��--~----ap K----I-=C3- ----------M '---------------------------------------- Contractor's Name--............AOW/_Qf� -------------------------------------------------------------------_---------------------------- Phone.......................... Installation will serve: Residence C9'Apartment House ❑ Commercial ❑ Trailer-coup# Q– Motel ❑ Other ❑ '— Number of living units: ___(___ Number of bedrooms- Number of baths j___ Lot size _____�'t`--5_-----x.j4pY_'__:-f-------------- Water SuPPIY� Publics stem ❑ CommunitY system L�S,�ivate ❑ Depth to Water Table -------- ft. ' 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 JD---New Construction: Yes Fg�� FHA/VA: Yes ❑ No H 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___- p._ Distance from foundation_____1Q-____-_.Ma eri I__ i l?frl� .p _.e...... No. of compartments-------�__ _-__Size__�3___x_ X 5 .Li uid depth__Visfance Disposal Field: Distance from nearest well---- ��._Distance from foundation-----la----.__- to nearest lot line__�__.___. Number of lines_ "..• __._ Length of each line________? _�-------Width of trench._-___-_ i________________ Type of filteDepth of filter � Total length___-____.___ .. __---__.___.._. Seepage Pit: Distance to"rlePrest well----------------------Distance from foundation___________________.Distance to nearest lot line___-.__________ ❑ Number of;pits__-------------------Lining material-----------------------Size: Diameter------.__-__.----------Depth_-----------------------._____- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.________--_ ❑ Size: Diameter-----------------------------------Depth------------------------------ -----------------Liquid Capacity----------------------------9als.V1 Privy: Distance from nearest well ____--------------------------------------------Distance from nearest building------------------------------__--_---_. ❑ Distance to nearest lot line--------------------------------- -------------------------------------------------------------------------------------------------- ,�• Remodeling and/or repairing (describe :-------------------------------------------------------------------------------------------------------------------•-------------------------------- v ----- 4------------------<----------- --------------- ---- ------------ -- ----- ---------------------------------- -------------- ------ ------------- ------ ----- ------ ---------------------------------------------------------- -------------------------------------------------------------_--------------------------------------••--------------------------------- ----- ------ ----- --------------- --- ------------------- --------------- --------------- - --- ---------------------------- ---- ---- ------------ --- - ---- --- --- -- 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 regulations of the San Joaquin Local Health District. _____-__------------------------___ ________ __-..._--(Owner and/or Contractor) By:__ _ (Title)- ----------- -- --------- --- -- --- --------- lot plan, s living size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY EMICATION ACCEPTED BY DATE �� IEWED'BY----------------------------------- ------------------------------ --------------------------------------------------------- DATE------------------------------------------------------------ "G.PERMIT ISSUED.-----Y:---....----- ------------------------------------------------------------------------------------------------ DATE.__--------...--------------------------------------------------------------------------- Alterkfions.and/or recommendations:_ _-.SF _%1.4 _.-%- _"!_IC.OXe� ___ ____________ ---_.-_____ -. -. __ _----_-__-_ .__ ______-__-._-.___-_-___._ .___.______ - --___. _-___ _ ____________ - . .. ........., -- t.r_t _c_t.c. --;L,! i� . vc �_. _ �:�:_ �' �t_�.: 1n� >� t.r : FINAL INSPECTION BY:----- !. -------------------------- Date------ ----1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,CaKprnia _> Manteca,California Tracy,California y e F.P.CC.