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r�Kc�rri�t ust: F � --- --. -- _---.•---------------------------------_ APPLICATION FOR SANITATION PERMIT Permit No. --- ------- --------------------------------------------------------- (Complete in Duplicate) ---- --- --- I This Permit Ex fres 1 Year From Date Issued Date Issued 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 lCounty Ordinance No. 549. JOB ADDRESS AND LOCATION-----�i_/- - ---- ' p !/ � ---------------------- ------------------------ Owner's NarneOu--- ------------ - Phone ------------------- Address----.?,6/1 ...:P,�.--� �-------------,/1� -�1-------------------- Contractor's Name---C�F_ --- -------_a_--r __ Phone-------------------- - Installation will serves ResidefSce�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -..2-- Number of bedrooms -'/... Number of baths _;.__ Lot size __--__-757__ x-___-IS _____________________ Water Supply: Public system B—Community system ❑ Private ❑ Depth to Water Table 14_._ ft. �1 Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑' Previous Application Made: (If yes,dote---------------- No P— New Construction: Yes B---Ro`❑ FHA/VA: Yes ❑ No E_11�\ TYPE OF INSTALLATION AND SPECIFICATIONS: _ f" _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ��t� Septic Tank: Distance from nearest well-__----'----_.__Distance from foundation/b_ ------------ 1.. -______ ---------- _ ___________ . U9__ No. of compartments___. ________________Size___��_��-�F.d_r_`Liquid depth__.._.._'iC Capacity_1Lrs�� Disposal Field: Distance from nearest well-----------------Distance from foundation._/47-`__-_____-Distance to nearest lot line__,___--- ---- c�(1 Number of lines......... ........................Length of each line_lp-c-.r_____-_------.- Width of trench___ 4---------------------- Type --------_-___--_Type of filter materialr79_0(--------Depth of filter material---/_fs�'_______-__-Total- length___ o-!--_______________--_ Seepage Pit: Distance to nearest well---------------------- 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------------- ------ ----- ---------De th-------------- ----------- ---------------------Li did Capacity- gals. ❑ p q p Y- - - ---- - Privy: Distance from nearest well------------------------_------------------------Distance from nearest building----------.--_------------------ _-__-. ❑ Distance to nearest lot line - --- --------------------------- ---------- ------------------------------------------------------------------- -------------------------- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------- -------------------------------•------------------------ ---------------•---------------------------------------------------------------------------------------------------------------------------------------------------- '---------------- ------------------------------------ -----------I- ---------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------°-------------------------------------------------------- ------------------------------------------------------------------------------------------•--------•---------------------------------------------------------------------- -----------•----------------- ---------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statel ws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------- --- - ----------------- - --- - ---- --- ------------------------ -------------------- --------------- -----{Owner and/or Contractor) By:----------------------------------------------- --------- ----------{Tit1e)--------------------------------------- -- - --- -------------------------------- ------------------------------- (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...... -f----r -_C_�_-____________________ -------------------------------------------------- DATE--------- -----=,f--1-� REVIEWEDBY-------------------------------------------- --------- ------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------ -------------------------------------- DATE----------------------------- Alterations and/or recommendations:------ ---------- --- --------------------------------------------------------------------------- ------------------------------------------------------------ ------------------------------- ---- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------- --------------------•--------------------------------------------------------------------------------------------------------------•------------------------------------•------------------- --------------------------------------------------------- •------ -- ------------------ ------------------------------ --- FINAL INSPEG ON BY:- Date.---------3--1- -r(1�-- - -- - ---- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxellon Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F,P.CO.