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FUR Ul-l-K-L USL: APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------------------- .. -------------------------------------------------------- (Complete in Duplicate) ---------- --- This Permit Ex i4s; 1 Year From Date Issued Date Issued --(P__-_ _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.l ]/ JOB ADDRESS AND LOC/A�TION... ��,• - 1--��14 5-.'�-_.e�IfIPC�1t+ �'lw�------------------------------------------------------ Owner's Name--------------------4 ?&-4�------p 20 f-/------------------ ----------- - ---- - Phone------------------------------------ Address------------------------------------------------------------------0----1------ ----Cz_-5-4,0--------------------------------------------------------------------------------------- Contractor's Name----------------------------------------------------------------------------------------------- ----- Phone..?-3S Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A.... Number of bedrooms __a(__ Number of baths _/____ Lot size •-.-Z-----.9c1"gaq Water Supply: Public system ❑ Community system ❑ Private ER—Depth to Water Table 4-O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [ Aclobe ❑ Hardpan ❑] Previous Application Made: (If yes,date---- ---------------) No&O New Construction: Yes ❑ No � FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Now -0j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well 00----Distance from foundation----ZV---------Material__..._._CC1 C-- -------------- No. of com artments____-._ ------------Size---- '+ Disposal Feld: Distance from nearest well__.00..._.Distance from foundation-----ZK;�--------Distance to nearest lot line_____-_------ Number of lines______..___p�_____-- Length of each line------------ -----------Width of french-------p9_Y_*----------------- Type of filter material__ _ -!--- Depth of filter material___..--------------Total length_____----/6_v---------------------- 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---------------------------------------------------------------------- ---------------------------------------------------------------------� Remodeling and/or repairing (describe)---------- ------ - ------- ------ ----------------------------------------------------------------------------------•-----------------------•----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- ------------------------------------- ------------------ ---------------------------------------- ------------------------------------------ - ----------------------------- --------------- -------------- 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, a rul and regul tions of the San Joaquin Local Health District. (Signed)------- -- -- ----- ---- -- ----------- -----------------------------------------------------------------------(Owner and/or Contractor) By:--------------------- ----- ----------------------- -----------------------------------------------------------------------------(Title)------------- - --- (Plot plan, showing six lot, location f ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR 96ARTMENT USE ONLY APPLICATION ACCEPTED ___ ____ DATE_. �G -- ----------------------------- ------------ REVIEWED ----- ------ --------- REVIEWEDBY--------------------- ------- ---------------------------------------------------------------------------------------------- DATE- -------------------------------------------------------- BUILDING PERMIT ISSUE -----------------------------------------------•--------------------------------------- DATE--- --------------------------------------------------------- Alterations and/or recommendations:-------- - --- ------ --------- - ------------------------------------------------------------------------------------------------------------ --------------- ------------------------ ---------------------------------------------------------- -----------f -------------------------------------------------- ------••-----------------------•-----•--------------•---•-------------------- --------------------------------------- -------------------�--------- QULI� _.__LLr1 �_Cly. $ Q ----------------------------------------------------------------------- -----------------------------------------------------•-- . --- --- ----- •-- --- ----------------------------------------- ---- -------------- ----- FINAL INSPECTION :-_ -..___ Date.______ - --_la8______________ A AQU1N LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California