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rUK Url-K-t USt: -- -------------------------- ------------------- N __ ___________________ _____ APPLICATION FOR SANITATION PERMIT Permit No. 1, ... (Complete in Duplicate) 'x DateIssued --- This Permit Expires 1 Year From Date Issued -� ---� f 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. _ _ �_--_ t-_ x � j _ '� Owner's Name---- .,mwm---•-..5v �_ - --Yk -------------- --------- ---------- --- --------------------------- - ---- - Phone-------------------------------•-•-- Address_-_ ,e ,� - - , r'('/f�� ---------��-�- --------- &------� 1, " Contractor's Name---- -,e5,= ---- Phone_ _q - . --- Installation will serve: Residence ©Aparfrrfenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - Number of bedrooms Number of baths _/____ Lot size -Ac—_R_T::7A6F�_____-___________ Water Supply: Public system ❑ 'Community system E] Private Depth to Water Table __,7' ft. Character of soil to a depth of 3 feet: Sand ®f ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date............. .......) No F/New Construction: Yes ❑ No [-_'rHA/VA: Yes ❑ No ®-- TYPra WST,ALEATION AND-SPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) M Septic Tank: Distance from nearest well--- _----Distance frorp foundation---- --------Material_.. CQ CRE-l- ._--------_ No. of compartments.._____--_------------- _ X L -Liquid depth------- aCapacify- Disposal Field: Distance from nearest - _ w--eli....;-�_�'._Distane from foundation-----f __.__.Distance to nearest lot - line ��:- --- Tr' _--___c Number of lines--------- -�--- -- -------- --Length of each line-JW-7k-_5`0---Width of trench-------- Type of filter material---R0_C ��..__Defh of filter materia.._ - ------------ length__._-.._. __ ___ ----------- Seepage Pit: Distance to nearest well_____________________Distance from foundation---.---------f-----Distance to nearest lot line----------------- El Number of pits----------------------Lining material---------------.--...Size: Diameter----------------------Depth---------------------- - ---------- 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--------------------------------------- Distanceto nearest lot line --------------- ------------------------------------------------------------------------------------------------- -------------- Remodeling and/or repairing (descr�e): n:F_N�VI/ 5 `//f l --------••------------------------------------------=--------------------=----------------------------------------------------------------------------------------------------------------------------------- - - ---------------------------------------------------- I ------------------------------------I--------------=--------------------------------------------------------------------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -:r (Signed)-------- _ .- ._�._ - ' ,- ----- (Qwner_ and/-or-Contra4p-r .� By:--------------------------------------------- -------------------------------------------------------------------------------------Title 4 ` ------- ----- -------------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__TOR-0- --- :------------ -------- -------------------------------- DATE �f� ��4�� I --- \ REVIEWED BY -- ------------------ ---------------------- DATE----------------------- t - ----------------------------------- �----• I DING PERMIT ISSUED-------------------- Alterations --------------- -Alterations and/or recommendations:f----------_______--------------- ------------ ------------------------------• ------- ----------------------I--- -------------------- -------------------------------------------------- ------- ---------.---- ------------------------------------------------------------------- --- ----------------------------------- ------ ------------------- -------------- -------------------- --------- -------- --- ----� --------- - -- ---- ---------- --------------- --------------- ----------------------- --------- FINAL INSPEGTI.ON4___B :. L1 -'( - Date-- 1'� -f F-66= SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Haxelton Ave. "$00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F,RC C.