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rUK lJrril_C u3c: ............................ .._...__..__.. -- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .x.............. ----------------- --5------------- ------- (Complete iD ------------ ( omplee n uplicate) - ` _� e This Permit Expires 1 Year From Date Issued Date Issued ._�-/E_ 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 LO ATION _SIDS !`Av JZ ---- -Q-- ...------5--�r-------ES-C6.=iO&--------------- Owner's Name R R A.DYC1__L ----------------- --- ---------------------------------------- Phone._V7� Address------------ R7" = 3cX � _ ��/�}LOI� ' ----------------------- --- Contractor's Name__. � 1'�` - � --�1 _-�--- -- - Phone tf�=/}5 Installation will serve: Residence [9'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I---._ Number of bedrooms-._ Number of baths _Z Lot size ------/4!t;9F �__7 --- -----•-•-_-.----__ Water Supply: Public system ❑ Community system ❑ Private E�' 6epth to Water Table 25 ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No �ew Construction: Yes No ❑ FHA/VA: Yes [-No p, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \ II v 1� -- _.Mater al---C'D/1/C J ET Se tic nk: Distance from nearest well___._________Distance from foundation____ _ --- .------.Size--- ------Capacity_ 0 p ,g No. of compartments__.._.7_� X1D_x_�___Liquid depth.___.____...__ 1�� Disposal Field: Distance from nearest well.__.S0------Dist f�e fromfoundation___.ID Distance to nearest lot line-__�_.________ Number of lines________�3_____ ________________Len Pt'o� ach ine_F_4_ FO « Width of trench.._..-`1._,q_.__--_______._-_.---- Type of filter mate ria l__A.0.0�.____Depth of filter material__ J7----.-------Total length________________ ___--__ y� Seepage Pit: Distance to nearest well__-----_--------------Distance from foundation--------------------Distance to nearest lot line------------_.... ❑ Number of pits____------------------Lining material-------------.---------Size: Diameter---------------------..Depth............---------___._-__-_-- C� Cesspool: Distance from .nearest well_______ _________Distance from foundation-----------------_Lining material----------------------------_----_-__- C ❑ Size: Diameter-------------------------------------Depth----------------•-------------•---------------------Liquid Capacity-------------------------.-gal Privy: Distance from nearest well-------------------------------------------------Distance from nearest building..-------.-_.._-__---__--_--__.__.__-_-.-. ❑ Distance to nearest lot line----------------------------•---------------------------------------------------------------------------------------------•-•---------------- e Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------•----------------------------•--•----•-----•------•-- O -------•---------------------------------------------------------------------------------------------------------------•-----•-------------------•-------------------------------------------------------------------- --------------------------------------- ------------------------------------- ----------------------------------•------------------------------------------ --------------------•----•-•------------•-•- ----------•----------•-- ------------------------------------------------------------------............------------------------------------..............-..........---------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s,.and rules and regulations of the San Joaquin Local Health District. ($igned)_��'l/. _ --------- l (Owner and/or Contractor) By:....-............-------------------------------------------------- ------------------------------------ --------------.-(Title)........----•-- --------- 0 -------. (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--------- 1 L R ------------------------------------------------------------------ DATE..........7__=/ .-.. 6_0 REVIEWEDBY---------------------------------------------- ------------------------•------------------------------------------------------ DATE----------=----------------------------------------- BUILDINGPERMIT ISSUED----------- .------------------------------------- DATE----------------------------=------------------------------_-_- _ - _.. ______R V1S �__....._ a _Alterations and/or recommendations:__-_-_-- vT__ -_ __o___________ --------- .WT------ ------D-F---------EFE4..tE_A-177 ------ T ------------ --- -- ---••------•-.....-•---------- • --- -------------------------...----- --------• :..---- ----_::--•-----------------------------•----- ' `�FINAL INS Date_.._--------_ -__--- SAN JOAQUIN LOCAL IAEALTH DISTRICT 1601 E.Na:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California 1 Manteca,California Tracy,California J i.P.CO.