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rUK ust: w: a �RA _ ----- ------- -------- -- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No:,l�'-? �--_. --------------I-------------- (Complete in Duplicate) Date Issued Z Z Z-L-q _ o23-22- '", ---___-______ ____ ____----- --- --- --- --- This permit Expires i 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. � I This application is made in compliance-w.ith_County Ordinan e No. 549. T-04 JOB ASD LO ATION !_� 1 ` a I D 1>~_ -- -- ac _ . Owner's Name -lam aJ.T _ A ---- --------------- ---------------------------- Phone------ ---------------------------- Address---------------•--9.11:9�------- RT_H---------- _ _�.: ::= 3- ----------------------------------------------------------------- -----__ Contractor`s Name-MAN-T ------�`�---SPT_[�.------ �'I��-1..C�-•�I---------------------------------- Phone--------------------------------- Installation will serve Residencef Z"Ap�artment House ❑ Commercill ❑ Trailer Court ❑ Motel ❑ Other ❑ ; Number of living units: __!____ Number of bedrooms .�_ _ Number of baths � Lot size _-_ . 14 Water Supply: Public system ❑ Comm nity system ❑ Private E` Depth to Water Table __!-- ft. Character of soil to a depth of 3 feet: Sind Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application,,Made: [if yes,date._ ____.__..__..___1 NoL2-New Construction: Yes � ❑ FHA/VA:�Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (Na septic +ank.or cesspool permitted if public sewer is available within 200 feet.) /01.. Septic Tank: Distance from nearest w:ell____15- __ Distance from foundation__--_`�__... ~--------size--- _4 - q de�h---��.�^.Capacity----- -- N x_ �.�Li u� y P No. of compartments-_ ___ - ---- d P`."-_.Dis#ante to nearest.lot line___ Disposal Field: Distance from nearest well,_4._0_ Distance aft.A.foun anon.__, E_ air „ L g [ � Number of lines________________ _-:--_-__-_---Lengt' of each IineL�p_.� _�.�� Width of trench --------------------------..------.---. a- t Type of filtermaterial-_ [ _ --Depth of filter material-----1_C__.�- Total length---_-_--~>' `_�__ ��.I c3 f Seepage Pit: tistance to nearest well-----------------.__._Distance from foundation------------------- Distance to nearest lot , € P� line__ _________ ❑ Number.of pits________________ _ __ ini9rmatenal� Size;°Diameter Depth=-- l-------------------------_- Cess ool: Distance from nearest well- __A----Distance from foundation__ Linin material---- -------------------------------- 1 -------------------------- izme = 1-- -------- ----- _ -. _. _ Liquid Ca acitYElSe: Diater-__----- -_ DePth• . . _- -._-__' gals Priv Distance frnearest well _____________ #�buildin . _- ❑ Distance to nearest lot line. -------t---4---_------------------- Remodeling and/or repairm,g�..�describe� --------------------------------------------- ------- -----• -------- --------------------------------- -- i ------------------------ = _ _— === _- = =—:__ '------------------•-------------- ----------t-------------------- -------- t-•------------------------ ------------------------------------------ - -------------'---------------------------------t -------------- ----- •---------I,---------- ---------------------- --------- -------------------------- 4 11 ------------------------------------- i---------- --- -------------------------------------------------------------------------- ------------------------------------------------------------- I hereby certify that I havelprepared this application,„and that the work will,be done in accordance with San'Joaquin County ordinances, to laws, and;rules and egulations o San `oaquin Local Health''Dis4rict. (Signed)_: _ Z -._-- _-- _ _ - (Owner.and/or_Contrac#or)� 0 BY ' ------------------------------ ---------------------------------------------------------. (Title)-------------------- ` ------- (Plat plan, showing size- of Iot�. location of system in relationto wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED i3Y _-. - _a »---------=------'.-----.. ----------------- ------------- DATE------- '� REVIEWED BY-----.. _ - DATE------------------------ i -- ---- BUILDING.PERMIT.ISSUED------------ ----------- -- _ - --------------DATE--------------------------------- E aerations and/or recommen afions. - °= - v r.+% ------------------ ---------- ------- -------------------- -------------------- ------------------------------------------------------ --------- ------------------------------------ ------------ --------------------------------------- - --- +- - JJ FINAL. INSPECti B Date---------- --Ae- /,5 - 0 - ------------------------ - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 r]. w..