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rUK Ul"llK t W)t: -:1-- --fes.-_------_02_ -------- APPLICATION FOR SANITATION PERMIT Permit No. .. ...... F A --------- (Complete in Duplicate) ------------------ This Permit Expires 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.ap -- lication-is made,in.,.compliance with County Ordinance No. 549, f"7 q030,0 i�"•70.i,►::,fie= _D� ® I JOii ADDRESSND` ALOCATIO ,AA-- . L---- -,------lo -e- Gr-�t r- C� ' Owner's Name------- l '1-------...Znl ------ ---------------------------------- ---------------- Phone/ �61.._3_3_A_a_3 Address = -------------- e Contractor's Name------ -------------------------- �� -r`�" -------------------------------------------------- : ------------ Phone----------------------------------- Installation will serve: Residence C&, .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - _-_ Number of bedrooms _ "- Number of baths -/--- Lot size -----------, G_X. a--�-------------- f Water Supply: Public system ❑ Community system ❑ Private �( Depth to Water Table ___------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Or Hardpan ❑ t `� Previous Application Made: (If yes,dote--..-- --------_----) No* New Construction: Yes Ia No ❑ FHA/VA: Yes ❑ NoAe S TYPE OF INSTALLATION AND SPECIFICATIONS: ( septic nk•:or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: is aDistance from nearest well__ _l_ Distance from foundation_47----.__-_ _- No :•of,comartments_.--sa�-----------------Size Material-: x X,S":_.Liquid dep _ 0- ._.-".--_-._.--Capacity_Aa ___ Ir � p --- th-__ Disposal Field: Distance from nearest well-- -- "Distance from foundation-/ ____..Distance to nearest lot Number of lines--------_--?- g 3 /� -------------------Len Length of each line_ "Q"-^.�"Q-IR-QWidth of trench--- Type of filter material _� � o -_______Depth of filter material_ :Q- -______--Total length----,/ Seepage Pit: Distance to nearest wet!_ r7Q----"-"-Distance from foundation--- �-------Distance to nearest lot line_-,S_�___._- f� Number of pits____------------Lining material--- a _____-Size: Diameter-__ 3 9i _//___..Depth-_o _ '� Cesspool: Distance from nearest well-----------------Distance from foundation_...-.--------------Lining material------_.._.--.__-------.-_----__._-_ T� El Size: Diameter----- -------------------------------Depth---- ;-------- =, ,:_---------------------------Liquid Capacity-----------------:---- -----gals. .. r Privy: Distance from nearest well---------------------------------------------°._Distance from nearest building-------------------""-"--._.------..__---- ❑ Distance to nearest lot line-------------------------- ------- ------ -------------------------- Remodeling ------------------------Remodeling and/or repairing {describe}---------- ------------ -------------- --------------•----------------------------------•----- ---------------------------------------•----- j -------•----•----------=-------- -- ------------------------------------------------------ CCii ,r. F .1 ------------------------------------------------------------------------------------------------------------------------_-------------------------------------------------------------------------__----------._------.--------- ti I hereby certify that I have prepared this 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. J� .(Signed)---------------------------------------------------------------------------------- ------------------------------ --------- --------------------------(Owner and/or Contractor) �7. By:-------------------_- ----------- --- _:eo --------------------------------------------------------(Title)----------------------------- ------------- --------- ------- - (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 - . - '-- ----- ---------------------------------------------------- ----- DATE- `- G REVIEW! D BY '-- ---- --- ----------------------- ------ DATE------------------- BUILDING PERMIT ISSUED------------------ ---------- ------------- c ----- DATE Alterations and/or recommendations:..5�-_" F � - - '-- - --------'- ----------------------------------- --------------- ------------------------------------------------ ----- - ------------------------------------------------------------- -------- -- --------------------------------------- -------------------------I------- ---------------------------------- ----------------------- ---------------------------------------------- -•------------ ------------------------------------------------------------------ ------------------------------ ------------------------- ----- --- - ................. ------------------ -- - ------ --------------------------------- ---------------------------- - ------------------------------------------------------------- FINAL ,INSPECTION. BY:----- - �_ __ �_ - ------.._ Date-------------- ---- /6� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street t 4i-.124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C{7- IF - ._�