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r K tA-t-K-t USt: - —� r --------------------------------- - _---__.-.._-_ APPLICATION3.FOR SANITATION PERMIT Permit No. Z111.7, _ALL --------------------------------------------- ----------- (Complete in Duplicate) -------------------- ------------- ----------------- --------- --- --- - This Permit Expires i Year From Date Issued Date Issued I 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION- _- /?.-/ -. jT'pTf?<✓ i Owners Name------•------------ ,Q_ Phone- 6 32. Address ----------R--e> ( -----QX----- Contractor's Name ° � - ------------------- Phone---,__A----'. `��Q_7 " Installation will serve: Residence j5d Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. --1--- Number of bedrooms. Number of baths._�_w_ Lot size ........ Supply: Public system [I Community system [] Private'0 De_pfh"toMWefer Table -------- ft. Character of soil to a depfh of 3 feet: Sand El Gravel E] Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No I New Construction: Yes ❑ No 9 FHA/VA: Yes ® No � TYPE OF INSTALLATION AND SPECIFICATIONS: ' ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepfiicT$ Distance from nearesr well__ L7 f..-_Distance from foundation---W__/------ Material-- __c i'--- S No. of compartments------- ..-_Size_ U�_f�-J��` Liquid depth_..--_ 1�0�-��__._Ca acit 1 �V P y--- Disposal Field: Distance from nearest well-------------- Distance from foundation--------------------Distance to nearest lot line- El ----__----._._-- Number of lines-1 ---------------------------------Length of each line------------------------------Width of trench------------------- -_--- ---------- Type of filter material--------------------_.---Depth of filter material---------------_-----_Total length------------------------------------------ r Seepage Pit: Distance to nearest well-------------------Distance from found ation--------------------Distance to nearest lot line----__..---.___-_ s ❑ Number of Pits. Lining material- ---Size', Diameter------------- --------Depth--------------------------------- W Cesspool: Distance from nearest well------- -.`'Distance from foundation--_'._----_-_---___.Lining material--------------------0 Size; -- ----- �i p _ :. ------Liquid Capacity----------------------------gals. , - -------------------------- Privy: D stance from�rnearest well--__ - -------------e-{h--_---,---_ --- Distance from nearest buildin ❑ Distance to nearest lot line---- '-- c L, 9jr ---------------------- Remodeling and/or repairing (describe):-_- --__---1?_/. __ �—' � -------------------------------------------------------- t -T1 --e'er/ ------------------------ --------------------------------------------------------------------------------------------- -----------------------------•-------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cour ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Ify (Signed)------------ ------------------- -------------- ---------------------------------------------�---((Ow and/or Contractor) BY: (Title)---------6_!�61`r_/ ....... (Plot plan, showing size of lot, to ion of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.--.-- r - ------------- r5'S'— -------------------- DATE------- REVIEWED BY. �� .................... ------------------------------------------------------------------------------- DATE --------- - -- ----------------------- BUILDING PERMIT ISSUED------------------------------------------------------- ---- ------------ DAZE--------- -------------, - - ------------------------- - ------------------------------ Alterations and/or recommendations:-----------------------------_ --------------------------------------------------- -------------------- I-------------------------------------------------- ------------------------------- -------------_--------------- - ---------------- -------------- ------------ FINAL INSPECTION ------c- -:.-_v-_ Date______. ( SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave, h 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.