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I-UK Ul-HCE USE: - ---------------------------- --------------------------- / APPLICATION FOR SANITATION PERMIT Permit No. ._. �P__ - .7 ------------------ ------- ---------- ------------------ (Complete in Duplicate) - ---------------- This Permit Expires i-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 d ed. This application is made in compliance with County Ordinance No. 549. /� p / �'�✓ n in /� _� a ®� CARD�rJ pv , � JOB ADDRESS AND LOCATION__ t-------------------�----�i----- �-z. - —AD: ? 1 ._ -.of F -- -------- - --- --------- - Owner's Name------------- r=- ��- � Phone__. ------------------------------------------------ ---- Address__. ��Z ---... L WAY- Contractor's AY Contractor's Name---C _1_.L- _. -- ---------------- Phone--------------•------------------- ------------------------------ Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: _-r____ Number of bedrooms -2,_ Number of baths Lot size --��_�-----�� -_--------•------- \ Water Supply: Public system ❑ Community system !/Z- ❑ Private eDepfh to Water Table 102—ft. Character Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (Ifyes,date---,i------------__) No New Construction: Yes 21'< ❑ FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest well___�t7>-'--Distance from foundation---10--------Material_0Z(VC __ � tr R---- �:-------- No. of compartments________--_---_-.-_Size_-X-1�__K--�--Liquid depth_.__��-----_---___CapacitY___��'Ca'___- Disposal Field: Distance from neares well__ ____Distancelfrom foundatiorj_____-A Distance to nearest lot line---_s-- Number u Number of fines______ - --_- --+-__________Length of`e-ach line_��.5___ f� ____ _-- of trench_____--_-, Type of filter material--- ----Depth of filter-material__ / ___..`------- length_._____I/ ____�__�-_.- ----- - - -------- Seepage Pit: Distance to nearest well___-----------0'_r_Dist nce from foundation--------------------Distance to nearest lot line_/:_"__�'__.... ❑ Number of pits---------------/-----Lining material---------!!-__-size: Diameter-----------------------Depth----------- 'r=I------------- y r SVM ° Distance from nearest{�+,vell__sQ... _.D,*an ce from ourydation_-_.�Q_--___.Lining material____ -c)pD. Size: Diameter-3- X- ±_X-----------------Depth--__'> - ----------- Liquid Capacity ��---- gals I-IFAC}i Distance from nearest well---------570------________________________ Distance from nearest building +__------------------ Distance to nearest lot'line$____ .__ L ' g �� _ 111 �Gr ' .LDM Rdc,�.x � '�enrcr►�s �,.- Remodeling and/or repairing (describe)---- ------------- P -a- � ------F t A-V _0 -t �-` r sr-t R ,.c nl y-- ----- _ 'TI.Rc► -----------------------------------------------------------------------------•---------------- -0 ----------------------- ----------------------------------------------------------•------------------------------------------------- ------------------------- -- `=41-- -----------`-------------------------- I hereby certify that I have prepared this application and that the wo'rk,will be done in accorclaneeawith San Joaquin County ordinances, State laws, and rules andr4 gulations of the an Joaquin Local,Health District. L (Signed)._ ------" - ------------ ---- -----------------------------------.(Owner and/or Contractor) By: r � ---------------•-•------------•- - --------------- ----------- --• ----------------- ------- -- rile----- ------- ---------- ----- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I A r FOR DEPARTMENT-USE ONLY' APPLICATION ACCEPTED -----------------------B--Y-- t. � - - R�-_O t �.ws ~ ----------------------------------------- DATE---REVIEWED BY BUILDING PERMIT ISSUED-------------------- „ -------------------------------------------------------- DATE- '-�•----� --------------------------------------------- - -----------�---�------- -- ' - •--- --- -------------- - - •- --------- DATE__ Aterations and/or recommendations:------------------------- ------- -- l � ------------------------------------------------------------------••----- •----------�--T-- . . 6. _ . ------- ----------�f��- - ------------------- ------- -------------------------- ------------------------------------------------------------------------------------------- f ------- ---------------------------------------------------------- FINAL INSPECT Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT -i 1 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street � 205 West 9th STreet Stockton,California Lodi,California Manteca,California Tracy,California, CC 9 REVISED 9-S9 3M 3•'53 F•p.CO. x