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FOR OFFICE USEr. ._. ------------------------------------------ APPLICATION FM SANITATION PERMIT Permit No.--------------- -------------------- --------------------- ----------- (Complete in Duplicate) - �- /.1� ,Z—.� ----------------- --------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 7 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 L CATION--------f- R-�7��f ------A_L-R-P -RT------W -------------------- ..................... Owner's NameA ------ -------------------------------- _ Phone------------------------------------ Address--------------------------ZIS0------d---------- ---'----------------------------=-------------------------------------------------------- Contractor's Name------40-Irk-N-ER • ----•----------------------------------------------------------------•-------------------- -•----......... Phone----------------------------------- Installation will serve: Residence O�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms- Number of baths E------- Lot size ------ --------------------- Water --------------------- Water Supply: Public system ❑ Community system ❑ Private WDepth to Water Table--_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ElAdobe ElHardpan [�T' Previous Application Made: (If yes,date--------- --------.-) No 2 New Construction: Yes ❑ No HA/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--�.__ Distance from foundation_-AD ---------.Material----C'0/16�(�F "�------- p9 No. of compartments---' ----___.--Size--3_X-�-�5-Liquid depth_.��------_Capacity....AV 0.... Disposal Field: Distance from nearest well__:---_-Distance from foundation....ZO-----.---Distance to nearest lot lin ---- Number - Number of lines_-_---_--/---------- - ------Length of each line_--1�Q,-�_�__r�.-.Width of trench-_-.-'z-V-.-----.--------.--- v Type of filter material__-_XpC_�-___Depth of filter material---_--f--f- -------Total length-----------------A00--------..---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----._---------. ❑ 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-------b--------------------------------------------------_------- --------------------------------------------•--•------------------- Remodeling and/or repairing (describe):----------------- -_.�5.71r=7 -----•---•-••-------- •-----•-------- --------------------------------------- - ------------------------------------------------------------------------------•--------------------------------------------------------- ------------ 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:.- --- --------------------------------------------------------------------------------------(Title)--------------------------------- ---------- (Plot plan, sowing size of lot, to on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------`T-f-&,-0-`-------------------- -------------------------------------------- DATE----- -.6-7--- BY---------------------------------- ----------------- ----------------------- --------------------------------...... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------•----------------------------------------------------------------------------------------------- DATE---------------------------.--------------------------------- Alterationsand/or recommendations---------------------------- ----------------- ----------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------ ------------------------------------- ------------------------------------ --------------------------------------------------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------- ---------------------------------------------- -- .... ----------- - --- ------ --- --------- --------------------------- FINAL INSPEC --- --- - Date------ ------ --- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.