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FOR OFFICE-0SE: - ------------------------------------------------------- - a �- - APPLICATION FOR SANITATION PERMIT Permit Na. ------ -------------- ------------------ ---------------- (Complete in Duplicate) Date Issued .'-'-- -. .---- . .•- This Permit Expires 1 Year From Date Issued _ 'p Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desstibed. This application is made in co. li nce with County Ordinance No. 549. JOB ADDRESS AND LOCA ON--- 'A± .T ...- __��30 ------- ---------- oF-----J`?` R LD------AVE--�r Owner's Name-----=-------MAR.,l..Q----------�__AR t.J--------------------- +---------------------------------- ,pp�� 1.3.1-F1041 . --------------------------------------------------- Contractor's Name N_T VM�-' 011� ---------------- ---------- --------------- ----- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer+Grew* e Motel ❑ Other ❑ I Number of living units: -1------ Number of bedrooms Number of baths -1----- Lot size .---4-CRje�A-6--�----------------------- Water Supply: Public system ❑ Community system ❑ Private 6R--Depth to Water Table 957ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ E Previous Application Made: (It yes,date-------- -----------) No 2---'New Construction: Yes to E] FHA/VA: Yes ❑ No [-"— TYPE.OF INSTALLATION AND SPECIFICATIONS: .r. '---- —�--r - {Na septic tank or cesspool permitted,if publii-sevrer•—is available"within 200-feet.) •=-- - _I Septic T k: Distance from nearest well -.-Distance fro foundation_. p-....._-Mate�ial__� �[''-C. - -------- No. of compartments.-.--.�1�---------size__'5_X_ x_5_Liquid depth ��-------Capacity--- �------ _. 1 Disposal Field: Distance from nearest well-.-. Q..._Distance from foundation-----Ia-------Distance to nearest lot line----------------- As Number of lines-------------�j--------------------Length of each line------I40 (- -----.Width of french------i y--•----r------------, a� Type of filter material---R C_J`-,._Depth of filter material... /---F-----------Total length-------------IQD------------------- W Seepage Pit: Distance to nearest well----------------------Distance from foundation.....--........._._.Distance to nearest lot line.--.....---...... h ❑ Number of pits------------------- --Lining material-----------------------Size- --------- -------Size: Diameter-- .------------------Depth------ ------------------ ----- 4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.--------.-.-----------. p ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity_ --------------------------gals. Privy-. Distance from nearest well---------------------------------- ---------.----Distance from nearest building-----------------------.-----------------. S ❑ Distance to nearest lot line------------------------------------- ------•--------------------------------------------------- ---------------------. Remodeling and/or repairing (describe): � � P R jT # --=---------------------- ------------31---------------------------------------------------------------------------• ----------------------- L --------------------------------------------------------- - ----• --- ------ ------ ---- ---- - ---- -- q y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Count ordinances, State,laws, and rules and regulations of the San Joaquin Local Health District. .. �l -------------=------------------------------ -------{Owner and/or Contractor) (Signed) ---- -- - - '- --� --------�--�"--� ---- (Title) - =- -.� (Plot plan, showing size of lot, lots sys in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY b -------------------- --------------------------------- DA -----------��. APPLICATION ACCEPTED BY__--___-�_LZ-�d--'--------�- TE REVIEWEDBY---------------------------------------------------------------------------- ------------------------------------------------ DATE--------------------------------------------- -------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------ DATE--------------------------- -------------------------------- Alterations and/or recommendations:-------------- ----------- - ------------- ---------------------------•---------------•------------------ --------•--------------------------------------- 'FANhS SNS' - lu,, --------- -� --------------------- ------------------------------ ------------------ ---------------•---------- --------- - ------------------------------------------ -------------------- ------------------------ --------------------- Date------------------ FINAL INSP ION BY:- - -- ---P-- - Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r Cl.