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FOR OFFICE USE: -_-_. -J.- _ --- APPLICATION FO,& SANITATION PERMIT Permit No. -------------------------------------- ------------------- (Complete in Duplicate) ------- This Permit Expires 1 Year From Date Issued Date Issued 7�� --------------- ..../,/," ----------------------------- 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 A --------------------------- ------- ------------------------------------------------------------- - Owner's Name------Wt----•-V_4' -YN_A.A1- 70-------- Address------------ --------- Confracior', ......... ------------------------------- Phone_!P� ir--2, Installation will serve:.,,Residence ❑ Apartment House E] Commercial E] Trailer 4;Rrrf W Motel El Other [I Number of living units: lk Number 6 m uf bedrooms --- Number of baths --- Lot size ------ --------- ----------- ----- Water Supply: Public system E] Community system E] Private X Depth to Water Table 4/s�7 ff. Character of soil to a �epth of 3 feet:. Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay [] Adobe,®" Hardpan ❑ Previous Application Made: (If yes,date- -___._,.__--___] No New Construction Yes No E] FHA/VA: Yes 0 No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank 6_rcesspool permitted if public sewer is available within 200 feet.) 1 distance rom nearest t-6 - C#) S7— C66mc Septic Tank: �eare v;elI_�%5A_'_'___Distanc9 from foundation--- MaferiaI__P__.'�`_--__------/_ No. oF.compartments---------<9------------- ---Liquid clep�h----X-- ------------------Capacity-S-0-0 Dispcsa� Field: *Disfance.from nearest w0.,5_a--------Length .`.__!i1bisfance fiorn foundation---&_7-.!!---------Distance to nearest lot line--------!;�7---- Number of lines-------- --Length of�each line----474_1---------------Width of trench-- R------- --- -------- Type of filter mati I Depth of filter material-.-./S. ........Total length-.---- Seepage P Distance to nearest well--14.6............DistanceArom foundation----3,�--------Distance to nearest lot line__.S........ Number of-pits------/............Lining material__?(4 Size: Diameter----- Depfk--- -A --------------- i -?g:k- Cesspool: Distance fi4om nearest well-----------------Distance from foundation-----_--.----------.Lining material-- ------------------------------❑ --- Size: Diameter--------------------------------------Depf h------------- ---------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------_-.--_---- .--------.-Distance from nearest building_---.-..-----_-------._--___-______- , ❑ uilding----------------------------------- F1 Distance to nearest lot line- - ---- - ----------------------- ---------- ------------------------------------------------------------------------------------------------ Remodelingand/or repairing (de5cribe);--------------------------------------------------------------------------------------------- ---------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ---- --------------------------- -- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- --------------------------------------------------------------------------------L---------------------------------------------- ---------- -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyi ordinances, State lawf, and rules and regulations of the San Joaquin Local Health District. ------sz�v".C__e----------------------------------------------------------------(Owner and/or Contractor) By:------------------- -------le-J-7- ------------------------------------------------------------------------(Title)----- ---- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plac2n reverse side). FOR DEPARTMENT USE ONLY .4 APPLICATION ACCEPTED BY------ --- - ------------ ------ -- ------ ---------------------------------------- DATE....... REVIEWEDBY_��---------------------------------------- -- ------------------------------------ ------------- ------------------------------ DATE-------------------------- --------------------------------- BUILDING PERMIT ISSUED---------------------------------------- -- ------------------------ DATE--------------------------- -- --- -------------------- Alterations ------------------- Alterations and/or recommendgions:- ------�/-- ---------------- ----------------------------------------- ----------- - ----- -------------------- ------------------------------------------------------------------------------------- -------------- ------- ---------- -------------------------------------------------------------------- ----------- -----------------------q_:1 - ----- -- -- -------- 1 ---- 1 ---- ------ ------ ---f-------- ---------- 7-1 -----------'— L----AJ__1C ----------------- -----------------------------------------------------------------------------------FINAL INSPECTION BY;,.. _ --------------------- ) Date. ------------------------- �< 2, ---- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Streei 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00.