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--------------------------FUF}OFFICE USE: - ---- _______________________________________..__��-___ APPLICATION FOR SANITATION PERMIT Permit No. .__Z&:.C3- l-: (Complete in Duplicate) ------------ - ----•---- ---- This Permit Expires 1 Year From Date Issued Date Issued � s Application is hereby macI6!to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in ''ompliance with County Ordinance No, 549 JOB ADDRESS AND LnCATION___ . Owner's Na - Z --------------------------------------------- ---- Address---- ---.Q------ I� ---- -- -3-3-- = - -- - -- -----------•--- ------------------------------------------------------------- Contractor's ---- -Contractor's Name-------------- Phone- ---------- Installation LInstallation will serve: Residl nce partment Houseommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living uni : __. ____ Number of bedrooms __-____- Number of baths _ Lot size _6P_ _____ -_R.-A-6------------------- Ii Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table /.._X ft. Character of soil to a depO of 3 feet: Sand V Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made:{�I(if yes,date____________________) NoNew Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or-ctasspool-permitted if public sewer is available within 200 feet.) ��=-F IAO Septic Tank: Distance from nearest wel Distance from foundation---1_ -____-_.Material ______ No. of compartments...__,--_.___._.__Size' _�.� 5 /S'�iquid depth____.__ .. ` Capacity-RV-11' �r�L4 Disposal Field: Distaric4from nearesf well_2/ __Distance from foundation_a.�/ __-Distance to nearest lot`line�Q-f.___.. Number,of lines_.______ _ __ Length of each line'_i�__ -Y -.Width of trench- -3 ------ Type ofsfilter material. �. yp SII f --- _ epth of filter material----_,�� Total length----------------�`---- ' Seepage Pit: Distance:'to nearest well----- from foundation__________________.Distance to nearest lot line.-___.2.d_ ❑ Numberiof pits----------------- ---Lining material---------- ------------Size: Diameter.----------------------Depth------.----------------------_--- Cesspool: Distanc k from nearest welli ___.______._____Distance from foundation___________________ Lining material------..-_-_--._____.______________ ElSize: Diameter ------------ ---------------- Depth----------------------- -- ------------------------------___.___Li uid Capacity----------------- - ----gals. Privy: Disfancel-from nearest well--------_-----------_r----------------------.----Distance from nearest building----------_.______--____________.____--- ❑ Distance to rearest lot line--------- ---------- ---- ------------------ -- -------------------•-------------------------------------------------------------- Remodeling and/or repairing (describ e):__AVIV;___,40r_.---51.Z-�---VoAR_f_AN -S-----�,_K_-__8Eac J -- f _i-oIV 6VFz.XT 3�1 - _5AX5----mss 1'S x --------DE_S _n------ 60f�---- 3 iYt -----MWX--•-----u6EA_4_E. G d-1: ` ,Fi.-O_- --- -- ------ I hereby certify that I }ave prepared this application and that the work will be done in accordance withtSan Joaquin County V? ordinances, Stat ws, a dMies and r gulations of the San Joaqu' Local Health District. t (Signed)-------- --------- -- ---- ------------------------------(Owner and/or Contractor) f - - ------ -=�� • ` � —-----------v � � � ---{Title.__ (Plot pan, showingsize of lo �, location of system in rel on to wells, buildings, etc., can be placed reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- DATE----- - T REVIEWED BY Nh ------------- DATE-- 1%2` ' -- ---------- BUILDING PERMIT ISSUED-SII: ----------------------------- ------- ------- DATE------------------------------------------------- - - - ------------------------------ Alterations and/or recommendations------------------ -------------- ---------------------- ------------ - - --------I--------------------- 1 ------------------------------------ ------------------------------- ---------------------------- - ---- -- ------------- --------------------- :- - ---- -- --------------- -- ----- ---------- FINAL INSPECTION I ' 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 i F.`IIF.0 U. I I