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FOR OFFfCE USE: --------------------- -------------- --------- -------- APPLICATION FOR SANITATION PERMIT Permit No. .. .. .... ..... ------------------------------ --- -------------- (Complete in Duplicate) /o Date Issued ------ ------- -------- This Permit Expires 1 Year From Date Issued Z'eg — 10 —06 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appl' ation is made in com liance with County Ordinance No. 549. ESC i-o-N S t f S' iPN� �•�. JOB ADDRESS ANBD^LOCATIO ---------------- 1.'�-------��--------Y._&E----- F .f�_I G =------A- _--------------...------ Owner's Name-------M>l - Jv iz-Lam_••--- -- IAF-'- -- ------ - --------------- ------=------- Phone-----•------------------------------ Address----------------157-00------------C0__CA4_M_ff V---------��-=----------------- ---------------------------------------_--------------- Contractor's Name--•----e)V%J&j_F___R---------------_---------_---------------•------------------------------------• ------------------•--------- Phone----••-•--------------------------- Installation will serve: Residence e_�Partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms _ __ Number of baths _ ..___ Lot size -.-_-- - �-'._---. _ _ _-.---.._._>_._ Water Supply: Public system ❑ Community syst ❑ Private 91---Depth to Water Table s 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 t��New Construction: Yes 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 wek___.5__D_ ..._.Distance from foundation------C0--..-.-_.Material---- tr + NT` r ..,- No. of compartments...__7 ��__- --.-- ----Size__- _X__T_X_• ---Liquid depth----- �� -...._.Ca acit _ Disposal Field: Distance from nearest well-__-5.P ___Distance fromfoundation------10........Distance to nearest lot line_------------------ b [ Number of lines-----------7___=__......:.........Length of each line-- -p-' __- v--.Width of trench---.-�1�z_-!f___------- Type of filter material._. Depth of filter material-----1-9------------Total length-------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot 1ine----------- -_ rV Number of pits---.----- --Lining material-----------------------Size: Diameter------------------ Depth---__..------------------------- 1,3 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---------------------------------- -------------------------------------------- ------------------------------------------------------------- Remodeling and/or repairing (describe):------------- ----------------------- ---------•---- --------------------------------------- -------------------------------•-------------------.---- 1 -------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- ----------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------Z --------------------------------------------- -----------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------1 1 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. Owner and/or Contractor) ) O (Signed)---------- ----- _ BY---------------- ------ ------------------------------------------------------------------------------(Title)-------------•----------- ----------------------------------- L` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ��?? ��77 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 0-- ---- -------- DATE--------- --`-- - ~.-------- REVIEWEDBY------------------------_- ----------------- ------------------------------- ----- ----------------------------------------- DATE-------- -------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------- ------------------------------.-...--------- DATE------------------------------------------------------------- Alterations and/or recommendations:----e-/_7:- -4s-�--------I�-IS~-r--p�-�IZ1i✓i?�-----i ��-r—--------T--�--Gam`--------------- ------------------------------------------------------ ------------------------------------- --------------------------------------------------------------------------------------------------------------------- r h _____________________________________________ /--.^_ ------------ ___ ._ _- _ . ---------------------.-------------------_- --------------.------------.---------------- --------------------------------- FINAL INSPEC Q - Date------------- 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 r.p.Ca. t l