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c � FOR OFFICE USE: fff�l -2_V()---- -- APPLICATION FOIA SANITATION PERMIT Penni+ No. __!_- _. 1 � 7fi G C ------------- ..._------f-/t- - (Complete in Duplicate) / c s ------ ------ ---- Date Issued _-`?_ -__�__ --------------______-------___--------------------------- This Permit Expires 1 Year From 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 rrlade in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------- - ©--_ ---L-1........ a- - -_-- Owner's Name .. -�-- - sem--- 491 ---------------- --------- ------------------------------------------- Phone.----•------------------------------ Address_...-_-------------------------------�� ` t� Contractor's Name--------------� � �4_.4P�---------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms--7-`—Number of baths ---Z--- Lot size ----------------------------------------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 00-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Ado-be E�ardpan ❑ Previous Application Made: [If yes,date____________________} No E!r"" New Construction: Yes E41No E] FHA/VA: Yes ❑ No J9-1TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpublicsewer is available within 200 feet.) Septic Tank: Distance from nearest well--------- ------Dista ce from #oundation__I�_�------ _.Material__�O_A-------------------------------------- 2- No, of compartments-------' -------- --- Size - -- X - _4�7A---�-----Liquid depth.___._'r. -------- Capacity_-- ----------- Disposal Field: Distance from nearest well----------_-Distance from foundatio0(-C]_e----__-__ Distance to nearest t I•r,e J" N00 umber of lines___.____________________________Length of each line_______/ --- ._._.____.Width of trench.-c-. - ___._______._ Type of filter material__�1y ___ _-_Depth of filter material--_)_g-`l._-___-..Total length--------- --------------------- l}' Seepage f: Distance to nearest well------'_ --------Distancef om foundation-- _--/_-..Distance to nearest lot line-�-----._ 4 Number of pits______I_____________Lining material--- .-------.Size: Diameter__ Depth s'-1'5- e Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia)--.-._.-_____-__-_-_.-__-______-----El . Size: Diameter----------------- --------------------De th------------------------ ------- - ---- -----_Liquid Capacity_ gals. Privy: Distance from nearest well_--------=_-_______________'-----------Distance from nearest building.._.-...-----__-_-.--.-__-_-_-__----_..._ AA ❑ Distance to nearest lot line---------- --------------------------------------------------------------------------------------------------------------------------------- V Remodeling and/or repairing (describe)-----------�F' -- ---- A-C----- tom_ Y . . - ------------------ �. ---------------- I --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- hereby certify that I have prepared'fhis 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. (Signed) _ --- - (Owner and/or Contractor) BYL -----------------------------------------------(Title)-- r Itr,- ---- -- (Piot plan, showing size of I ovation of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___'r _. - 44e----------------- fSr(o�--------------------------- - - ---- -------------------------------- - - DATE_--- -�-------------- REVIEWED BY---------------------------------------------L------------------------------------ -----------------------------------------.. DATE------------------------ ---- BUILDING PERMIT ISSUED------------------- --------------------------------•------- ------------- DATE --------------------------------------------------- Alterations and/or recommendations:-_._--------------------------- ------------------------------------------------I------------------'--------- ------------------------------------------------------------- -----------------------------•--------------------------------------------------- ---------- --------------------- --------- --------------------------------------------I----------------------------------------------------------------------------------------------------- ------------------ --------- ---•------------- ------- ---- -•----------------------------------------------------------------------- --------------------------------------------------------------•-------------------- ------------------ FINAL INSPECTION BY:_ ----a._ �-�----------------- ------------ Date------/-//� F�/i 6 7................... ---------- ----•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 D.