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FOR OFFICE USE: -----------------------` "------ -\----------------- --------------- ----- -_--._ __-�- ___.--._-__-.-__ APPLICATION FOR SANITATION PERMIT Permit No. .. ...�w.. -------------- -- ---------`�-'-- (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 MT in,�om_pliance wit County Ordinance No. 549. � JOB ADDRESS AND LOC TIO0N---- _._f1F____ ARPOK---- T____Y 14/_-_6_R.PIS.Z .......Caw....RQ'vP Owner's Name------------ ---------NEWM 14 ---------------- ------ Phone----------•-------------•----------- Address-------- TE ` 2-- �� ---------1-3-42P-------11/(A N_TC -------------- Contractor's Name---- OW-A IR-P------ •-- ---•------------- Phone................................... will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- -- Number of bedrooms _____j_ Number of baths (_______ Lot size -__-_-__�_____X-------272_-__-___-____ Water Supply: Public system ❑ Community system [Private ❑ Depth to Water TableI5___ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_-------------------) No ©/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 Tank: Distance from nearest well_C_t_!v---_Dista9cy from foundation--10 M teff I-_CCQ_t C_ _F__L�___.___. No. of compartments------2-__ ______ ize___ ___x_.�Q._ Liquid depth----- es--____Capacity---/'�W_P._. Disposal Field: Distance from nearest well__.-�_�--Distance from foundation-----1__Q-------Distance to nearest lot line. ----------- �� Number of lines_-________l__________ _____ Length of each line_-__go____'--- Width of trench.______-____Z_�_�'._________-. T e of filter material___ . Q_�_._ tr J yp ---_Depth of filter material______--___---Total length_____-------_--._.9A`-:_______-- Seepage Pit: Distance to nearest well----------------------Distance from foundation_-_-____-_.-_____-.Distance to nearest lot line--_------------ 1-71 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):------------------------------------------------------------------------•--•-------------------- --------------•---------------•-----------------------• ---------------------,----------------•--------------------------------------------------------•-------------------------------------------=-------- -------•---------------------•------------------•------------------ ------------------•-----------------------------------•-------------------------------------------------=------------------•-----------------------••------------------- -------------------------------------------------_- D 1 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. _______________________________Owner and/or Contractor) By: Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sidle). n FOR DEPARTMENT USE ONLY --J APPLICATION ACCEPTED BY.......-f-t-R----------------------- ------------------------------------------- DATE------- - REVIEWEDBY--------------------------------------------- ------------------------- � - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------- --- .51fl -------- -------------------------------------- DATE---------------------------------------------------------- Alterations and/or recommendations:- -------- ------------------------------------------------ ------------- •----• -------••--------•---•---------------------•-------- -=- -------•----------------------•-----------------------•----------------------------- --------------------------------------------------------- -------------------------------------------------------------------- -----------------------------------------------------------------------------•-------•---------------------------------- •-----•------------ -----•------•------•----------------------------- ------- -- - - --------- ------ F -- ---- -------------- -------------•-•--- -•----- -----•--------------------- ------------------ FINAL INSPECTION BY:. .�.__ `-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. � 4