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FOR OFFICE USE: _ - -------------------=-- ---------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. 7� --------- --- -------------------------- ------------ (Complete in Duplicate) ----- This permit Expires 1 Year From Date Issued Date Issued 03,14.E 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 complia ce with County Ordinance No. 549. I l- JOB ADDRESS AND LOCATI N---- Owner's Name _ _ 1/1. _ 1r¢}_R ---------- C_[ � p Phone Address--.--R Confractor's Name__LAK_DA1_,.i -__.-_ 1U_ R -1- ----- �-r - ---- f ------------------ Phone------•----•--------------••------- Installation will serve: Residence ❑ Apartment House:E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ff"�CH001— Number of living units: ------- Number of bedrooms ........ Number of baths -------- Lot size 7.__.._.i7r_�_ -76& -------------------- Water Supply: Public system ❑ Community sys em' ❑ Private K Depth to Water Table ft. Character of soil to a depth of 3-feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------.__------) No�New Construction: Yes ❑ No FHA/VA: YesNo ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: `. .,._.(No septic,tank or.cesspool-permitted;,if,public.sewer is available within 260,feet.) �. q �4 Septic Tank: distance .from nearest well_________________Distance from foundation--------------------Material------------------_____..______-___.._-___.___. t l l NC— No. of compartments---------- ---------------Size------------------- ---- ---Liquid depth----- --------- Capacity Disposal Field: Distance from nearest weli__ A00.....Distance from foundation.---/t-_.-_.__.Distance to nearest lot E7f�F1 14 Number of lines--------- � r� Length of each line_-1�_ ---__-----3_r --.Width of trench_...__..5 --------------�--. ' ADD Type of filter material-_ O.CA.....Depth of filter material_.__-.f-___._.___Total length_________________ Q_____---- t3 x, 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-ne�aresf well__-_----- ---------------------------------- ---ADistance from nearest building------------------------------------ ❑ Disfance-to nearest lot line------------------------------------------------•------------- ------------------------------------------------------------------------------- p Remodeling and/or repairing (describe)_________ __________ - -------------------------------------------------------=---:---------------------------------------------- r ------- -------- ------------ § ------------------------------------ : ------- - ---------------------- ------------------------------------- --------- - --------------------------------•--•----------------------------------------------------------------------------- ---------------------------- : 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. CP �� B - 1 _._. i >= yl . - (Signed] LF, �Q�{E _ _ /.. ---------------(Owner and/or Contractor( '1 .Plot Ian, showin e of lot ocatio {_ lam!R {Title)_ (_PC .....Dist- --------------- ( p g n of system in relation to wells, buildings, etc., "an be placed on reverse side t. t.` -' — 1 l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_...�_Ri,C0-,-___.__-__-_---------------- -- ------ APPLICATION DATE �� - , _ _ .. REVIEWED BY ----- ----------- - --------------------- --------------------------------------- DATE-------- - - BUILDING PERMIT ISSUED----------- ------------- -------------------------------------------------------------------- DATE.- Alterations and/or recommendations:-------------------------------------------------------------- ------------------------ ------------------------------------------------- - --- -------------- -- I --------------------------------------------------------------- -------------------------------------- ------------------------ ---------------- : 0 ------------------------------ ----- - ----------------- -.--------------- -- - - ::. 4 '�_ --h f FINAL INSPECT! N $Y: / s'°°r .=f: Date---------------- yam:` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co. _ `