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FOR OFFICE USE:. --------------- -------------------- ---------------- Z -- - ---.-__-.-__---.-_- 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 co lance with County Ordinance No 549. S _ 'A , JOB ADDRESS AND L ATION....AI_RPQ'_RT-------- ---.r? .-.--. -......_Wou>.1A_/A.Rt>--- ------------ n s- Phone / -7A- 3-s Owner's Name 3"1 �A_R-�_ (�1_Tt`�. Phone - �` /Rte AddressT�--`... 3 --------3_ -J-�-------------M-TC --------------------------------------------------•--------------- Contractor's Name Q_1/t�(1�,(�-�-----------------------------------------------------------------------------------------------------•---- Phone......................------------ Installation will serve: Residence 9- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/---- Number of bedrooms A---- Number of baths __1___ Lot size ___ _.k-1,57-0----------------------- Water Supply: Public system ❑ Community s em ❑ Private Q Depth to Water Table __ -_ ft. Character of soil to a depth of 3 feet: Sand/Gravel E] Sangly Loam ❑ Clay Loam E] Clay E] Adobe E] Hardpan ❑ Previous Application Made: (If yes,date---.-----_-._.---.) No ew Construction: Yes 2lq.❑ FHA/VA: Yes ❑ No 21 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermittedif public sewer is available within 200 feet.) Septic T k: Distance from nearest well____ lA_.._ Distance from foundation:.___/6.,.,__.Materi _�D1CRE.TZ:--------- No. of compartments__.__ .-_.____----__ .� !-_X__J�_____Liquid depth_.,f1 �__-_-Capacity_____ Q-Q___ �- Size___ _.____ Disposal Field: Distance from nearest well--_�t�_-.-Distance from foundation----/0---------Distance to nearest lot line... - __. tc Vt Number of lines______________�. .____Len Length of each line_______ I� ---------- 9 ��-- -----.Width of trench---------�Q--�------------- Type of filter material-___R6_0<----Depth of filter material____-1_ _____________Total length-------------S�_-__ _____-_____- Seepage Pit: Distance to nearest well-----_----------------Distance from foundation....................Distance to nearest lot line----------------- ❑ Number of pits------------------_---Lining material_____ ---------------.Size: Diameter---------.-------.-----Depth-----------------___.------------ .`1' Cesspool: Distance from nearest well-----------------Distance from foundation_-_----------------Lining material_.--------------------------________-� ❑ Size: Diameter----- -------------------------------Depth--.------------- ----------------- ----------------Liquid Capacity---------------------------gals. Privy: Distaoce from nearest well----------.--------------------------------------Distance from nearest building-_.-____.__.-,____,____________.___-_._. ❑ Distance to nearest lot line----- --------------------------------------------------------------------------------------------------------------•--------- ------- Remodeling and/or repairing (describe):--------.-_.------------------------------------------------------------------------------------ --------- -------------- ----------------------------------•----------------------------------------------------------------------------------------------- --------------•-•---------------------------------------------.. I here certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tate laws, and rules a d regylations of the SantJoaquiocal Health District. c (Signed) 4 ----------- -- - .(Owner.ancfjor :Contractor) 4By------------------------------------------------- ------------ -------------------- ---------------------------------------------(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------�►R__0-------------------------------------------------------------------- DATE----- / ----------------- REVIEWEDBY------------------------------------------- ------------------------------------------------------------------------------- DATE------------- ---------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---- - ------------------------------- Alterations and/or recommendations:-- ,� -� Gil dc7!. --TllJ, w .......... -------- - ----------- --- ---- ------- - ---- --- --- hlLl - . .4�n - _ -1 f'r-1 `ty� FINAL INSP BY- -------- --- - ------ ---- Date--_-------- hywa o /- - -66 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.