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FOR OFFICE USE: • `APPLICATION FOR SANITATION PERMIT Permit No. . .5� ------------------------------------------------------- (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 compliand with County Ordinance No. 549. JOB ADDRESS AND LOCATIO .�1_C�.PVR_--..- U19y Owner's Name----------------�Q�-- •---------CA.RD_0._19----- -------------------------------------------------------------- Address C? _.. = !v`rC/ ---------------------------------•-- Contractor's Name----1'-4'PM.......C'OL___J-F-------- -- •---------•--- Phone......................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �,9a,4, Number of living units: ___I____ Number of bedrooms .2--Number of baths -1------ Lot size ___-._ I __a.___`f'_________________ z Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table _12-4t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------._._-) NoW-*New Construction: Yes ❑ 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 > k: Distance from nearest well__jC__W--_Distance from foundation----M -_-------.M- ateri 1__C0e�K .F ---- --. V ------------Liquid depth---- ------Capacity..j.Z- Q•No. of compartments------2- ._____ •Size / )e 9- Disposal Field: Distance from nearest well__��_-_Distance from foundation.10----------.Distance to nearest IcLt line�.5_..__...... Number of lines---------------- -----------------Length of each line----- _� Width of french------------ _.__.._ Type of filter material._�_0_C_�_Depth of filter material------1. _._. ----Total length_.__________________P-_?....... ._.. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F Number of pits----------------------Lining material-----------------------Size: 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 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 _V1 4te...o By L-----•-••- (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 BYpDATE-------! �`�--------------------- _..___T.1\-.�®___�_.___-_______._.____------------------------------------. �- REVIEWEDBY------------------------------------ -------- -------------------------------------------- --------------------------- DATE-------=-------------------------------------------------•-- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ---------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------- ------------ --- --------------------------------------------------------------------------------------------------------...................... -----------------•-------------------------------•-------•---• - --- -------------------------------- --••----------•------------•-----------r------------------•--------•------------•------------------------- FINAL INSP TION BY: - - --- --- --- xln_�77 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