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FOR OFFI E US ----// /�------ �. - --- --------------- 3_oAPPLICATION FOR SANITATION PERMIT Permit No. uplicate) This Permit Expires 1 Year Date Issued - ---�' ----- -------- - ---- - ------- - - (Complete in D."From Date Issued / - Fr, 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 ounty rdin-ag/ceo. 549. JOB ADDRESS AND OCATION------- --"'-- ---- ----------- ------ ------- a Owner's Name a --- Pho ` � .� Address--•--------------••- --------------------------------------------- -- -------------------------------------------------------------------� -•- Contractor's Name �CY- - - [1�i..---- c--1 _ -_-- U ---------------------------------- Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms �/--- Number of baths _)---- Lot size -----6.-i,,!_._-f�---.�-.�_��-_--_ Water Supply: Public system Community system E] Private E] Depth to Water Table _4 loft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Claydobe Hardpan F1 Previous Application Made: (If yes,date--------- --------- 1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifApbli; se er is available within 200 feet.) f Septic Tank: Distance from nearest wellDistancp from fou da ion-_-_-� _---__.Material______ _ -------------- 1, ------------- - No. of compartments,_--____ -____ __Size }Cg�_)C.-- -Liquid depth-- - - ----.-.---Capacity- moo Disposal Field: Distance from nearest well_/ __Distance from foundation--- P--------Distance to nearest lot�line------ �- Number of lines--- ---__ _--__- ____--Length of each line... -F0----------------Width of trench *,Vf" i--------.-------- Type of filter materia Depth of filter material--------/9-- !.Total length------------------- e_-*1--------- 01 Seepa a Pit: Distance to nearest well_#4 au�----DistanceQfrom foundation_--��---.Distance to nearest lot line----t�------_ Number of pits----I--------._-.---Lining material-�-� ��?_._-.--- _ p �-�. ✓✓✓��\ /___-- Size: Diameter----- �f _ De th------ -�--------------- 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__ ------------------- ------- -. � C Remodeling and/or repairing (describe):------ --------- ------- ------- ------- ------------------------------------------------------ ----------------------------------------------- ---------------------------------------------- ---------------------------- '.,C,:Zz4 ----- ----------------- - -- ------- --------------------------------------------------------•------------ ------------ ------------------•-------------------- -- -- ----- ----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St t laws, and rules and regulations of the San Joaquin Local He h District. (Signed) - 1 �LF'r`�./�' - -- 4QwTxw-ax,*Wr Contractorl By:------------------------------------------------------------------------------------ rc, ----ITitle)---------- ------------------------ ------- - - - ----- (Plot plan, showing size of lot, location of system in relation wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------- ------------------------ ------------ DATE------`- - - ----------------------- REVIEWEDBY------------------------------------ -------- ------------------------------------------------------------ ----------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- -- - DATE------------------------------- ----------------------------- Alterations qnd or recommendations:---------- -- -------- -------- - --__------------------------------------------------------------------------- ------------------------------- �/-6-6 � ---------------------------------------I----------------------------------------------------- ---------------------- --------- --- ------------- ------P-------------------------- ----------- ------------------------------------------------------------------- ----------`--�------ ----------------------------------------- FINAL INSPECTION BY: ---- '---------------------------------- --- Qate.--- 11---9- !0�` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ifoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.0 O.