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Vul<vl-HU ubt: �r ------- ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit -- ---- --------------------------- --- ---------------- (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 complian a with County Ordinance No. 549. ZZ Lit?. (] Esc ALON JOB ADDRESS AND LOCATI SiDE - R -----.RD--------- ----N-- �7. /2--Q Owner's Name------•----- _ �. Q_t_ _ P one ne__---- --- 04 Address---------------•-----R __p-.�------- I_16Q---,8 � C, 1_0_ Contractor's Name---E------&NT.H.QNy- ` ......S- N-,-----------------------------------------••----------------------. Phone--------•-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _____ Number of bedrooms ___ Number of baths��ot size ____ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table =10 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 New Construction: Yes 2--No ❑ FHA/VA: Yes Z-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.sewer,is available within_200-feet.),-,_ _� Y Septic sank: Distance from nearest well__,S0----Distant from foundation__/10_________Matei I---- ------- No. of compartments______7______________Size__ sY1_ax___..�__Liquid depth---- .-_--_---Capacity_____f_ 9_4:7 Disposal Field: Distance from nearest well..-�Q-----Distance from foundation_____ P 40 to nearest lot ling S. .--__. 1 ______________--Length of each line-_�30" d` .Width of trench._____~• ------------------- 70 Number of lines---____-� _----------------- -- l Type of filter mafierial_ -.--Depth of filter material._.-__---------._Total length_______________________ --_------- I Seepage, . Distance to nearest well-___14-6_._---Distance from foundation_/O----------- Distance to nearest lot line...!'__.__ !, Number of pits___________________Lining material_ C: Size: Diameter.__a6?_______----Depth__._..2_�` __...___._ � } Cesspool: Distance from nearest well---------------__Distance from foundation___ ----------------Lining material__._.__________.____._.__________..__. ❑ Size: Diameter--------------------------- - --------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------- from nearest building----------__._______----____..__._..___.- ❑ Distance to nearest lot line------ -- -------------------- Remodelingand/or repairing (describe}---------------------- ---- -------------------------------------------------------------------------------------------•--------------•------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- - -- --------- 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) t'r't __(Owner and/or Contractor) By:--------- �---- - --------------------------------------------------------------(Title)------ ----------------------- ------ ...._.. .............. (Plot plan, showing size of lot, lb ion odd y tem in relation to wells, buildings, etc., can be placed on reverse side).----- FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY---------'r.il__-=-q-------------------------- ---------------------------------------- DATE------/e._'__%Z .� ? REVIEWEDBY------------------------------------------ ----------------------------------------- - ----------------------------------- --- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations----------- ----------- --------------- ----------------------------------- --------------------------------------------------------- ----------------------------------------------------------------•-------- -------•-------------•------------------------- -------•----------------------I---------------------------------------- ------------------ --------------------------------------------- --- ----------------------------------------------------------------------------- --------------•--------------------------------- - ------ --- --- -------------- ----- -• -- ----- ------------------- ------ -----------•--------------------------------- ---- ----------------------- FINAL INSP ON BY. ------ ---- -- Date_ _-_. .. .......-- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.