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HUKUH-K-L USt: �-- a- i ---------------- i7` �� ----------- --------------.------------------------------ APPLICATION FOS SANITATION PERMIT Permit No. ..---. -•-•------••- _ ----- -- -------------------------- ------------------ (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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------- 6 -14 ------ ------------------------ Owner's Name --- - 144=; --------------- 30 � ----------------- -------------- ---- -------------------- ------------ hone---2,-.35:7�-:T}-- ----- Address------------------------------------ ----- . ------------------------------------------------------•---------------------------�--- -'-r- Contractor's Name--DAU - OA&_1. ------ 4 _LCltArS Y» -A4e-- Phone------ n3- .7 •� Installation will serve: Res*iae'n� 2"'A artment House Commercial ❑ L_f p ❑ ❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: ----- -- Number of bedrooms _ � °�:.- Number of baths ---1--- Lot size --------1-----A-'------------------------------- ----- Water Supply: Public system ❑ Community system ❑ Private [JY epth to Water Table jft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ �! Previous Applicaf ion Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _-(No septic tank or cesspool permitted if,.pubiic..sewer,,is available within-200-feet.) Septic 1 nk: Distance from nearest well 4�1-------Distance from undation---1Q-- -___. Mated L---.------------------_------------.----_--_. No. of compartments---- __ � ------Liquid depth-----��----_ Capacity____ ----- ----Size---17// ' Disposal Field: Distance from nearest well_/A30-.....Distance from foundation---- -.-- --Distance to nearest lot line--- f_---. [•�� Number of fines_------------Q -----._ Length of each line------80---------------.Width of trench...-o�----------........----------- Type of filter material&P-. _. --Depth of filter material-_-/�-------------Total length-------14-(7_---_------------.-_ � v Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ 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---.-...--.--------------------.---------. ❑ Distance to nearest lot line - Remodelingand/or repairing (describe)---------------------------------- ----------------------•---------------------------------------------------------------------------------- 1 ----------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V� ------------------------- ---------- ---------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)----------------------- ------------------------------------------------------ --- ------------------------------------------------------------------- -----------(Owner and/or Contractor) I :._{Title}= - ----------m..—_ - - (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 99 APPLICATION ACCEPTED --- -- --- A4----------- - - -- ----------------------------------------------------- DATE--------gr - 7 REVIEWEDBY------ ------ -- ------- --------------- - ----------------------------------------------------------------------- DATE BUILDINGPERMIT ISS D ------------------------------ --------------------------------------------------------------------- DATE. Alterations and/or rec mendafions------------------------- ----------------- -•----------- --------------------- ------------------•-------------------------- ------------------------------------------------------------------------------•---------------------------------•----------••------------- -------------•---------------- ----------------------------------------------------------------- --- ---- --------•------------------------------------•---------------------------------------------------------- f ----------------------- -------------------------------------- ------------------------------------- ------------------------------- -------------------------------- -------------- -----------------------•-------------- --------------- ---------- ........ - ---- - ---------- -- - --------------------------•---•--------------------------------------------------------------------- ---------------------- -------- --r FINAL INSPECTI BY:~ -------- -------- ----- Date---------- JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.