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U t ust: �� _ -- ------------------------------ ---------------- APPLICATION FOR iSANITATION PERMIT Permit No. ------------ -"------------------------------ ----------- (Complete in Duplicate) / - --- ( This Permit Expires 1 Year From Date Issued bate Issued _6/ J I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework rein escribed. This application is made in compliance with County Ordinance No. 549. 1. .� JOB ADDRESS ANDLOCATI N._ r. 1- tt Owner s Name---L A ----- - - ---------CC `----- ----... -Ph -one-------- -__-Ir-�'7� � ------------- ------------ -- -- .-- r -- Address---------------- "-Q ----------------------- ---• '----- Contractor's Name--------- - _ _ ------ - Phone.4_�a.4__"_.��__�.3-,Z ------------ - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [� Number of living units: -Number of bedrooms __✓Number of baths __L._ Lot size -----12..___C1.& --------------- Water Supply: Public system [] Community system ❑ Private Depth to Water Table -60- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay p ❑ ❑ Y ❑ y ❑ y ❑ Adobe)o Hardpan ❑ Previous Application Made: (If yes,date____________________) No 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.) Ir ; Septic Tank: Distance from nearest well_._,5Q......Distance from foundation__-._1_ No. of compartments--------�k=-----------Size_s-�XS__-,?�___�------Liquid depth----- - -----------Capacity---ter --------- Disposal Field: Distance from nearest well--+S_?_---..-Distance from foundation-----10___------Distance to nearest lot Number of lines-----------1-----__ -------------Length of each line----------� _+_-..........Width of french_-------fir "----- 'i Type of filter material•_ - _Depth of filter material_______-- --------Total length-----------------t o---------_ - I Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------_____.__.Distance to nearest lot line______________ ❑ Number . ofrpits--""_ ---------Lining material-----------------------Size: Diameter----------------------Depth------------------------------ --- Cesspool: Distance from nearest well ._._.______Distance from foundation___________________Lining material_._.._____________..___._ ❑ Size: Diameter----i---------------------------------Depth---------------- ---------------------------------Liquid Capacity----------------------------gals. S Privy: Distance from nearest well------_------------------------- _------------..Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line________________ - ---------------------------------------- 1.► Remod lin nd/or re ai4n ( scribe):___-____4 -- 1----------- ------------------------------ -------------------- _._---------------------------------------------------------- f ---------------------------------------------------------------- .---•----- -- ---------------------------------------------------- -------- ------------ -- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguiations,IOU fhe;San Joaquin,Local,.Health District. (Signed). t ' • . -- --- -------- -- ; -- -------"-.___k.__________...___.__.(Owner and/or Contractor) Plot Ian, showing size of ]cit, location' of stem in relation t--`-5-------------(Title)--------------------------------------- ------.------- ------------ - --------------- --------------- ---( P g r n +o wells,.buildings, etc., can be placed on reverse side). I F. -.. _. 'FOR DEPARTMENT USE ONLY �AP��P�LJCATJON ACCEPT ---- -- --- }-l�l( - --- REVIEWED ------------------•-- DATE__. 3 `G Sr BY---------------------------------------------------------- -------------------- ----------------------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------- ------------------------------------- DATE - Alterations and/or recommendations:-'------------------- - ----------------- ---------------------------------------- ---------------------- ------------------------------•------------------------------------•-------- ---------------------------------------------------"---- ---------- ----------------------------------- ----------------- --------- -----------------------------------------------------k----- - -------------------------- F1NAL INSPECTION BY:_____�_ bate - ---- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.