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FOR OFFICE IQSE: ---------- ---------------------------------------------- __ ; ___________ ___-____-____-_____-.__..______. APPLICATION FOO SANITATION PERMIT Permit No. _ ✓7 __ ' --------------------------------------------------------- (Complete in Duplicate) ----------------------- This Permit Expires 1 Year From Date Issued Date Issued �O__.1_- - 12j? — Z3 0-- 0? Application is hereby made to the San Joaquin Local Health District for a permit-to construct ainstall the work herein described. This application is made in compliance with County Ordinance No. 549. SCf} LQ1v j� JOB ADDRESS AND LOCATION Si D 1.�I- � � s-------W----- F-.....5NTi9____ F____R}? 4 Owner's Name `L _ _ _ _ } ---------------j Phone------------------------------------ Address----------------F%Q:----1�.Q_X---------1-7-7----------E-S_C0._L=QI_V_-------------•------ Contractor's Name--------OWN E-K---------------•-•----------------------------------------------------- ---------------------------------•--- Phone----------------------------------- lnsfallafioA will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __.1____ Number of bedrooms Z'Number of baths J____ Lot size ----ASR.F.._---------------------------------- Water Supply: Public system ❑ Community system ❑ Private [R'IDepth to Water Table 3!?7 ft, t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E�' i Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No PT 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-6-0___ Distance from foundation----10-------_-Mater•al-_._Ca 2ET ._______- No, of compartments-------- Size_.x__7 Xs___Liquid depth___>' Az--__-___._Capacity___ Disposal Field: Distance from nearest well __-O-----.Distance from foundation----ID---------Distance to nearest lot line___-------------- ( Number of lines_________ ____________________Length of each line_ -��--pp- f----------- �I Type, of filter materiaL__..�Q.C_K___-Depth of filter material-/ ` - �__ ..... otal length-------------______/�-____-_____-_. Seepage Pit: Distance.to nearest well._._S!5 _------Distance from foundation-----AOL------Distance to nearest lot line_.S_ EEr- Number of pits.------- -----------Lining materiaSize: Diameter.SX.7_--.__Depth----1_r____ ----------________ 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 ------ ------ - - --- ---------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)---------- ------------------------------------------------------------------------` --------- ---------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ----------------- -------------------- ----------------------------------------------------------------- , a ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, aws, and ru s nd regulations of the San Joaquin Local Health District. (Signed)____ _ Q�_-_ ___'_______________:._.._.._____ ___(Owner and/or Contractor) 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----- _ _Q............. _______ DATE___': _.___-r.- 5 REVIEWEDBY------------------------- - ---------------- -------------------------------------------------------------------------------- DATE--------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------- ----------------- - ----- M -------- ----------------------- -----------------------------------•--------------------------------------- 3. ________________________________________________________________________________________________________________________________________________________________________________________________________________________ _..__.____..________________________________._.__._-_-----.____.__._____...._.-_-____.-____-..-.____._..__--___._.__.________-_______..__.._______.____________-_____-__-_-_______.___.____________.-__---____-__----.-.-______ FINAL..INSPECTIO -- --- ---- Date l...� Z.L. 5'~--- --- - 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