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FOR OFFICE 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. JOB ADDRESS AND LOCATION. rV bt s sID iK Owner's Name----y-A� -lo-my�-t=E----•-----b_.A. -&:.y---------,---•-------------------- --------P--h--o--n--e------------'--�- -5-----,- --------- - Address . ..t. Contractor's Name----------------------Q-,,.-A-r--- h=.................... Phone14&--_--P .X.. Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -A----- Number of bedrooms RY_ Number of baths -1------ Lot size 5-----Luz-:d--------------------------- Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table 247 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No X New Construction: Yes ❑ No 5r- FHA/VA: Yes ❑ NoK 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___--_-______--.__-_--.-_._--_-___-_-----__--_-•. ❑9!'icL5fV6 No. of compartments--------------------------Size--------------------------------Liquid depth------------------------- Capacity-•-------------------- Disposal Field: Distance from nearest well---%S_t._Distance from foundation-_.2.D.......Distance to nearest lot line-Z10---- Number of lines---073iW.C_4i--------Length of each line----7.5...............Width of trench------� _.l--------------- Type of filter material-------------------------Depth of filter material-----------------------Total length______-_________-_----.-___--.-_-____-_--- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.----------- 01, ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---.-------------------Depth-------.-.----.-----------------lt- El 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------------------------------------------ ❑ Distance to nearest lot line----------------- -------------------------------- -------------------------------------------------•-------------------- : 4 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 nd regulations of the San Joaquin Local Health District. (Signed)------------------ y a4-0 - S------------------------- - - -(Owner and/or Contractor) BY� G " '�s�LA --------------------(Title) - ----------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place' on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- '-�------------------------------------------ DATE- --------- /F -Jr-------------------- REVIEWED BY-------------------------------------------------------- ---jr ------------------------------------------------------- DATE---------------------- ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------- ------%�----------------------------------- DATE------------------------------------------------------------ ° —Alterations and/or recommendations:_-- S - �_---ej9k--r...._ �_-_ -_-_--- -- 1c;yS-rE�l. -------$Z's" 'rA- -------- 5........7 `--1-QC4....._VW$------1�sTA-l-1_- b----- ---- . tf QW nP s------------------- A:- --------- w -----------6.y�� ------- ---------------- ---------------- ---------------- ------------- ----------------------------------� l'? / �roa� / Ft Lf= FINAL INSPECTION BY: ----- �__-_- -. - v Date-19/a_�-----------------�----- -��-- -7 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 F.P.CC. - -