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+,. t-UK F -K-t USE: F�- - ---�-- -------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------------- (Complete in Duplicate)- This - _ ° ;--- This Permit Expires ] Year From Date Issued bate Issued ------- __ S Application is hereby made to the San Joaquin Local Health District for a permit to construct and installwork�erein described. This applica�tiionn is made in compliance with County Ordinance No. S49. Owner's B ADDRESS ANp L CATION_:r� � .7 - p� --IV -Cd---I 11f �/ er s Name------- - _ "��' — I Cr11MSHf�?-1�1�_ - = --- =,Y'� .-. P U....c nI hone ---------------- Address-----•-- `Z7Q �^ �`' F}._(�d.� SL �`�` --t�- .�'Z3 RN- Contractor's Name-- Owj-1t4----- - ----- ------------M--------- ---------- - Phone---•-----------•-�-------- Installation will serve: Residence P!r"-Apartment House 0 Commercial E] Trailer Court ❑ Motel ❑ Other El Number of living units: _ ---- Number of bedrooms -a- Number of baths 'Lo _ t size ---_----_-___-.- ater Supply: Public system ❑ Community system ❑ Private Depth to Water Table T_ 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 P?---New Construction: Yes R g-, [] FHA/VA: Yes [] No 6''.- TYPE .OF INSTALL..AT'ON.AND.SPECIFICATIONS: _ - (No septic tank or cesspool pe rmitted if public sewer is available within 200 feet.) Septic Tank: Distance4rom nearest well___ C _Dist� from foundation- -- _ No. of compartments_._--; "°~`'e-Size-- .PPA-5---_---Liquid depth-_._ Ca acit a Disposal Field: Distance frorri'-neatestswell---�G --"--Distance from foundation/-�"T� ^ y ------Distance.to,nearest..lot line---_ ®� Number of�'ii est--« ;------ Length of each line-----111Q' d Width of trench _-_" _ lrl'' Type of filter material_?0_I��------DE th of filter material----�� length--.7 p -- -- -----------Total ----'�Q ------------ •., tp ie , ------------ Seepage Pit: Distance to nearest well�•,�_______-------Distance from foundation--".11�._----- 'stance �,o nearest lot Gne__---- ❑ Number of" its_- :_-._ p Lining=materia(- ,DC __-__Size: Diameter _-X f Depth------- ---. _ _ 42- Cesspool: zea Diameter nbarest ell_____ ________ Distance from foundation,.---._ Tiring material-------___ t P ----- ---- ----------- ------ Depth------- ---------- ------- Y P Liquid Capacity- --------------gals. V/1 F Privy: Distance from nearest well_____________"__ --_______--"----------_------__Distance from nearest building,. -.. g----------------------------------- Distance - ❑ to nearest^lot line__ --�- -- _------_------ Remodeling and/ot-rep-airing-(desc;ibe]:__-_. ----------------------------------------------------- I - If ------------------ I ------------------------------------------------ ------------------------------------ ---------------------------------------------------------- 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,regul ' ns of the San Joaquin Local Health District. (Signed)------------ -- -------- - ---�-- v - � T .(Owneran or Contractor) By: --- �: — (Title)' }r-�.-....� [Plot plan, showing size of ]at, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4 t FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-- -- -- TI- -------------------------------------------- - - ✓p -- -- - � ------------ ------ DATE-•----REVIEWED ---------------- BUILDING-PERMIT --------------- BUILDING-PERMIT.ISSUED-------------------'------- ----------- --- -------------------------- DATE----- ---------- ------------------------------------- ------- . ------- ---=--------- -------------------------------------------- DATE------------------------------_- Alterations and/or recommendations:- ------------------- -------------- ----------PrT TQ_# C0VRsP ------------------- I ------ -- ------ - ------ ------- FINAL INSPECTIO , a ------ --- Date---- ��--------��.------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ?' 304 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California