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FOR OFFICE USE: _ — _ � --------- .�. '. .' Permit No. _,57-.49 ` - APPLICATION FOR SANITATION PERMIT - . --_-_-_-_-=-___ _ ______ _____- - ---_ (Complete in Duplicate) .Date issued -- - - ----- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein descrbe . This application is made in compliance with County Ordinance No. 549. �/s�i'i/6 Aw--sJ' JOB ADDRESS ANQLCCAA TION__ -- --- --- ------ - - --- - - _4�,-V7 Owner's Name--------------- Z--L-�, -j----------- ----, _TT - ......1, -------------"---------------•-------------------Address-- - 1� Contractor's Name__ lel Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _-- Number of baths f�/� Lotsize --- --- ------------ Number of living units: _,/---. Number of bedrooms„' f , Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table -5ft. PP y Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loa E] Clay, Adobe C] Hardpan F] Previous Application Made: (If yes,date---..---- -.-) No ❑ New Construction: Yes ❑ No [-] FHA/VA: Yes El No [I t TYPE OF INSTALLATION AND SPECIFICATIONS: [ ' (No septic tank or cesspool permitted if public sewer is available within 24Q feet.) s, Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material---------.--_-----"_----. ____.-------------- No. of compartments-------------------------Size--------------------------------Liquid depth---- ---------- ---------:Capacity---------------------- t Disposal Field: Distance from nearest well.-50_ from founds ' n._l ""-- ----Distance to nearest lot ine---------------" 4 "----- --------"----Length of each 4ine `_F -"�-i ----Width of trench---- .-'��--------- Number of lines_--.---_ r ------ Type .S Depth of filter material-_�'�___ - ----Tota! length_.__._ '- -----Type of filter material--- p _„F,,,,�.,,,, _ ., - i Seepage Pit: Distance to pits-1.__.Z ea est well_ Cb .- "--Distance frgtn foundation-140-----•- Distance to neparest lotline--,!;-------------- t`umber of its-_"--j" Lining material---- _Lining si e: Diameter-- -------------- -----De th__-srZ. J------------------ I Cesspool: from nearest well_.---_-.-_.---.-Distance from foundation.{------------- -Lining material__-=''y -- ----------- Distanceals. Size: Diameter- - Depth -(} ="'-------------- -----------------Liquid Capacity: ------' 9 i i_�-` Distance from building;----------- '-------------------� Priv Distance from nearest well----------------=------ °r*� -------- ❑ Distance to nearest lot Ime ---- --------- ------ ---------- - --------------------------------- • -------- --.,--- ---_�-- . 3i Remodeling and/or repairing (describe)-------- ---- ---LI - -��---- ------- r1l?1--( ----- ---- ' - ------ ---------------------------•---------------------------------------------------------------------------------------------------------- i _ i •"______________•_____•-__-_______---- ------ - ----" ----------- -------' - ------ ---------"------..------ ----- ---------- ------------- ':_ ------------------------------------------ - ----------------------------- ti ' I =---------------------------------------------------- --- � �..� +;++.+*� --------- ------------------------------------------- �.- . t,,.. .f T I hereby certify that I have prepSre6d tl is application and that the work will be done m accordance wi San Joaquin County y ordinances, Stateand rules and regulations of the n Joaquin Local Health District. t ! �f _.._._.-.- §wn and/or Contractor �. . _r- - --- -------------•- Si (Signed) / t 9 --- ---- ] ------ ------------------------------------------------------ -(Titl i (Title] l, plan, showing size of lot, ation!of system in relation to wells,, buiildincis,eetc., c� an be placed on reverse si e). FOR DEPARTMENT USE ONLY { Mi�1 � DATE------------ �� APPLICATION ACCEPTED By ----------- DATE------------------- �; t BUILDING PERMIT. ISSUED--------- - - - -- `' --- -- ATE ! -------------------------------------------------- A1+erations and/fir r&commen a ions:._.___.___.___.__.__. _ --------------- 4 --;----------------fi------` -------------------- ------- --------------- ------------- ------ I --------- '' "` ' ` -------------------- ------------------- - - ----------------- --------------------- --- ----- ------------------------------ FINAL INSPECTION BY:------ ��. � Date--- -- /----- .• --- ---------------------------- .._-------------"---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California stockton,California