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A F FOR OFfMCE USE: h ---------- --- -------- -- ----- - - ___--__--- AP LICATION FQR SANITATION PERMIT ------------------- ---------- Permit No. ___ ......... -------------- --------------------- ---- • -------- -- (Complete in Duplicate) 14- ._____________________________________._-_______. This Permit Expires 1 Year From Date IssuedDate Issued ___ k.5 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 cEliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATION_�S1P�____._ _.L/_�'_PO_R�_..41f� _____-70C,_-___2A______.�T ROP:: Owner's Name Q LZ_ p ------------------------------ -------- Phone------------- ----------•--•---_--- Address------------------�T� -- ----1 x........--�� A-•--- M-T-CA----1----------------------------------•------------------------------------ Contractor's Name----0WIVAU,----------------------------------------------- --------------------------------------------------------------- Phone--------------------.............. Installation will serve: Residence &,- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _3 Number of baths Lot size ___�`/�_�_ ..1C QQ. ^._--_-_---__ Water Supply: Public system ❑ Community system E] Private Private Depth to Water Table (2-_. 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 New Construction: YesjEr-_No ❑ FHA/VA: Yes F-- No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well •a�_�_____Distarico frora foundation---/�___-_-._.Mate ipl No. of compartments-.___ --_--_____._Size__VX/V_X_+�__._Liquid depth------ Capacity...f •©® Disposal Field: Distance from nearest well.___.J�.Q.---Distance from foundation...Z00--------Distance to nearest lot line ._.____. Number of lines-.--___�-_________ _______ --Length of each linen _' ____ � `_-Width of trench.____. 6-- �._.-___-----. Type of filter material- _____ __-RQ'.�___Depth of filter material----�� ------Total length___.__-�&..... .____12C Seepage Pit: Distance to nearest well____------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------- Diameter_--------------------Depth_..----------------------- _.__._ 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------------------------------------------- ----------------------------•------------------------------------------------------------------ Remodeling and/or repairing (describe :-------- -----•---------•------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------•------------------------------- ----------------------------------------------- -------- -- ------- -------------------- - I hereby er ify that I have prepared this application and that the work will be done in accordance with San Joaquin County .`ordinan s, t laws, and rules d regulati s f the San Joaquin Local Health District. (Signed) _ ---------------------------------------------------------------------------------(Owner and/or Contractor) B --- X,- ---- =- = ------------------------------------------------------------------------------ -----------------(Title)----- - -- ------------ -------------------- - ---------- (Plot pla , sowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.---h..�--- ---------------------------------------------------------------- DATE------- __--:_/_..-` 45-------------------- REVIEWEDBY----------------------------------------------------------- ----------------------------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------ --------------------------------------------- DATE----------------------------- . - ---------------------------- Alterations and/or recommendations-------------- -------------- ------------------------------------------------------------------------------------------------------•----------................ ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ----------------------- ---------------- --------------------- ----------------- ------- ---------------------------------------- - ------------------------------------------------------------------------------------------------ ----------------------------------------------------- -------------------------------------- / t--------------_ n ! --------- --- ------------------------- -------------------------------------------------------- FINAL INSPEGTLON BY ,: _ Z1/l - -------- -- -- 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 F.P.CO.