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FOR OFFICE USE: - --------------------------•---------- ------- ------------------------------- -------------- ------_____-___________________-________-__- LICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (Complete in Duplicate)P ) Date Issued __ d - -------------------------------------------.---.--- I 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 cl suibee This application is made in compliy n e with County Ordinance No. 549. MM JOB ADDRESS AND LOC TI01� 5 -C_/R�.i�ORT I'/VA- ----------' 4Q �� ATH ROPp . Owner's Name-----------------•—Ax ---------------A_uF1 E_K. __f- K_------- - -------------- ------------------ Phone_----------------------------------- Address---------------R�-`-•B----------- Contractor's -••-Contractor's Name---©W-N—ER.,------------------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms _`2-Number of baths _1_____ Lot size ----AjCR.EAE__________________._.__ Water Supply: Public system ❑ Community-system ❑ Private Depth to Water Table 15_-ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam R5' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------.-) No p-, New Construction: Yes 21"No ❑ FHA/VA: Yes ❑ No 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.---AQ--------- _____ -Materi I_.-CQ/UCRETE No. of compartments____-_.____ ize /�___y.___O_ -_.__Liquid depth --- __.-- --- Capacity------`�y�1zO C7 Disposal Field: Distance from nearest well__.J�' C)'....Distatc Tom foundation-----/Q........Distance to nearest lot line --------- Number of lines_____________ Length of each line_______ __ COY /-------------------- OQ-----;.------Width of trench--------- Type of filter material----RO-O_K___Depth of filter material------17-----------Total length__-_� 1"-_____�.�Q_' Seepage Pit: Distance to nearest well---.------------------Distance from foundation--------------------Distance to nearest lot ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.--------Depth-----------_________._________ Cesspool: Distance from nearest well-----------------Distance from foundation-----------_--------Lining material-_____.___________._____-__________. ❑ Size: Diameter-------------------------------------Depth ------------------------------------------------ Liquid Capacity----------------------------gals. E Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------.____._. ❑ Distance to nearest lot line-------------------------• - - Remodeling and/or repairing (describe):------------------------------------------ ----- •-------=- ---------- _--------------•--- J ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. (Signed)-------------------------------------------------- ----------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By:-----L:di`rl ------------------------ ---------------------------------------------------------(Title)------------ - - - - (Plot plan, showing size. o�t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----'71R-`0-'--------------------------------------------------------------------- DATE-------- - � REVIEWEDBY--------------------------------- --------- --------------------- ---------------------------------------------------------- DATE----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- -------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------- �f SANK >Aj_srA _c-a>.w------C14,94gis>r----/nl------4,61.0.07-- --_--_ �R> # To i op----• i ",.0ti ---- -- -- - ---- - --- - -- - ---- = -6�F` FAC/*-- >vo�r- eOvt E- ---- --® 'rte --- !K------ -- T- R - LION 1' =�—----------------- - - 66 t ,o ----------------------- FINAL INSPECY:. -- --- ------- -- Date-------- -----?/7/3_—__A- 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. r