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FOR OFFICE USE: ------------------------------------- - ----------------- ------------------------ --------_------- APPLICATION -------- ------- APPLICATION FOR SANITATION PERMIT Permit No. --------- --------------- --------------------------- (Complete in Duplicate) Date Issued _v/4,, ------------------------------------- --------- This Permit Expires 1 Year From Date Issued USO 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 comp iance with County Ordinance No. 549. M-r`cf:) W t 53 r g S -11'tSC ,, f JOB ADDRESS AND L CAI N_'5)1DE_...__ -- _ l-- T�r----- ---_ - -- ---------&F----.L�T7.1Ya-ESa/1__ Owner's Name------------- - L'FR-P;D-----•------ .� clg_ .Q. ---------- ---------- ----------- Phone------------------------__-------- Address `J-`----JQ x-------ZQ7 l----------M T`_C0q----'------------ ---------------------------------------------------------------------------- Contractor's Name d.WN_ _ w----------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House Commercial �E❑ Tr•aiEer Court ❑ Motel ❑ Other ❑ Number of living units: --- ---- Number of-bedrooms ... umber of baths _11 Lot size 76_CRE__C=,F— Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Tt. Character of soil to a depth of 3 feet: Sand.&_-Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,da#e.__.._.._____..__.I`No New Construction: Yes �o ❑ , FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well----------------!Distance from foundation------------------ Material----------------------------------------.-------- E� r1f1C-- No. of compartments----------- I------._._)Size---.... -------------Liquid depth---------------- ---------Capacity------ Ift Dis osal Field: Distance from nearest well Distance from foundafiori_____ p /___.__.__.Distance to nearest lot line__ __.. �+J Number of lines--________ i-----.__.__;Len th"of•each line__-_ 9 -��-------k- -- Width of trench--- -2.��--�-�------ ----• „p T e of-filter material-,R©.. 1 ,�`Q yp _ C1�.___Depth of filter material_____�9._.____.__Total length______________ _________s__________._ 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----- --------ilDistance ------- -Distance from foundation--------------------- material_ ------_____--___________-_..__---__ ❑ Size: Diameter_____________ ---------De th-___.-._._-_-._------------------ - --- - - --_-Liquid Capacity- - ------------------------gats. A to Priv Distance from nearest we11_____ f._ _,________________ _,_.__.-Distance from nearest buildin ❑ Distance to nearest lot line------------------------------- (-- ---------- - ------------------------------------------------ ---------------- ------------------------- 0 Remodeling and/or repairing (describe}: ---------------------------------------------------•----------------------------------------------------------- t--------------------------------------------------------------------------------- - -- -------- -------------------------------------------- - Ilf -------- ---�-------------------------------------------------------------•-------------------------------------------------------------------------------- -------------------------------------- -------------------------- 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, andrules and regulations of the San Joaquin Local Health District. (Signed),<� 1 a----- :-- t ------------_--- - _ -- ---------------- ----- ---- (Owner and/or,Contractor)- � Oor By:------------------------------------------------------ --------------- ---------------------------------------------------------(Title)--------------- -----------------------.._.... --------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). . r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- �. f' --•------------------------------------------------------------------- DATE--------- - REVIEWED BY--------------------------------- - DATE --------------------------------------------•--- --------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------------------------------------- Alterationsand/or recommendations--------------- -- - --------- ----------- ----------------------------•-----------------------•---------- -------------•-------•-------------- ---------- ----- ---- ----------------------------------------------------------- ---------------------------------------------------------------------------------------- •---------------------------- -------------------------- T, _ l _ FINAL INSP ION BY Date �� { -/---- -----------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California