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`* OR OFFICE USE: �G �i? o ------ ---------- -- J .------ `_"1 _=._�_�'. APPLICATION FOR SANITATION PERMIT Permit No. � 1 --------- (Complete in Duplicate) iI --------------- Issued 0 6`21t- Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalkthe work herein described. This application ismade ' compliance with County Ordinance No. 549. ' ` 8 'n/ ' zz✓c Fi4,S T` JOB ADDRESS AND LOCATION_._ ]- ---- -- --- ----•--- --.r�1�l---- ------------rte o� Owner's Name-------Z_A-I1e --------Z-A--V ` Phone --------- .. r� - .. __ Address--.-----------�. , fa` - - C'' � ' C. ! Contractor's Name--/_M_0.A4j3A-RT-.----CAC).�/ _�-E �p ------�,---------4 '.,41----- Phone._3 --�.._'S�d'� Installation will serve: Residence [I Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: i-n�-- Number of bedrooms _---- Number of baths ---- Lot size ----r-4R t.________•__-____-_ __ ------ Water Supply. Public system ❑ Community system [❑ Private X Depth to Water Table -------- ft. Character of soil`to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam)?l Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--- ,.....-.-) No New Construction: Yes X No ❑ FHA/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-/ , 7',-Distance from foundation----Q--.F_T.Materiai_ _-- No. of compartments------�-------------Size---iP_q_7¢4.44 Liquid depth------- 5''______-_Capacity--- _Ad.. 4,y Disposal Field: Distance from nearest well- OQ_firDistanice from foundation------f.1-AtIi.Distance to nearest lot line_-----------_--- f Number of lines--_--I---------------------------Length of each line--------*?)---�'x^.--_.Width of trench---- � ----- -----------•-- I Type of filter material_A-l" k� , Depth of fiiter material---- ------- length----- �'' 2':-----_-- Seepage Pit: Distance to nearest well--./_Y0_L,;Distance from foundation--- $__FT_.Distance to nearest lot line----------------- U, --- ------------I, Number of pits------/___. .---_Lining materia J'1--T?t-,G'C-.Size; Diameter------ . -i-r-- Depth-----X.5---�------------- -- I. {� Cesspool; Distance from nearest well-----------------Distance from foundation.-------------------Lining material----------- __.-----.---_-----__- IJ Size: Diameter---------------- --------------------Depth------------------ = Liquid Capacity gals. Z -- - Privy: Distance from nearest well____----------------------------- ---------------Distance from nearest building----____...__-________________-_------__ ❑ Distance to nearest lot Jine------------------ Remodeling and/or repairingdescribe):---_71-14-1-6--------- S--------- --------- VVV --------W ASA------ AS-i ` !'t✓ s------------- I 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, and rules and regulations of the San Joaquin Local Health District. I ' (Signed)-___ (__ - -- � - - --------------------------(Owner and/or Contractor) µ:BY w - ---------------------------------------------------------- ----------(Title) �C C`� -------- - -- -------- [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY---------- 0- 11 -- -- -------- -- DATE--- - ------------------------------------ REVIEWEDE I IS ----- - - DATE--------------------------------------------------- -------- BUILDING PERMIT ISSUED-------------------- D TE---_ Alterations and/or recommendations.---- - �� ------------ ------------------------------------- ---------------- ---------------------------------- --------------------- FINAL INSPECTION BY:-_... � - ,�,� - � - Date--.... p --------- ---------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1861 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California