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T_ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3 S Date� Issued a_�--�----1---- T"Z-. Application is hereby made tothe 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---------at...... }---.Box---159_.---�-4-1------ Qf---99-- Hi---Kay-------------------- on Hagan Lane Phone_9-4281----------------- Owner's Name----..�.`-�----�+-`---G:YkQ�.,94_T]1---------------- -------------- -------------- -7-------- -------------------------------------- -------------------------------- --•------------------------------------------------------------------------ Contractor's Name------------------De_jta----------------------------------------- -- - - ------------- ---------------------- Phone----_�--_3 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ----------:. .: .._. _ Number of living,units:a)-.r_,Numbe�ofYbedr-ooms -- �__ Number of baths ___1__,Lot�size ____-v AQYrq--_--------- __ � -� Water Supply: Public system.;❑ Community system ❑ Private E3: Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �- Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material---------------------------------------------- ___. �Xgri� No. of compartments------ ------------------Size--------------------------------Liquid depth--------------------------Capacity = disposal Field- Distance from nearest well_________________Distance from foundation_________-_-_____._.Distance to nearest lac line---------------- Number of lines ---------Length of each line-----------------------------Width offrench---------------------------------- N.T SxiU ing Depth of filter material----------------------Total length------------------------------------------ Type of filter material-------------------------- Seepage Pit: Distance to nearest well_-_1QQ_________Distance4rom foundation-----5_-----------Distance to nearest lot line_______ _______ ' Number of pits----d----------------Lining material-----bx'ik--_Size: Diameter.... Q...- �_-.Depth-----20 --------------------- fCess❑pooh Distance .from 7arest well_________________Distance from foundation_---____-___----__.Lining material-----------------------.--------- ❑ Size: Diameter. -- --- Depth- -- ----------- ---- ,. --- ---- ------ Liquid CapaciFY= =-= =' = =' =-gals- - ,> -- _ --------------------------Distance from nearest building------------------------------------------�(� Privy: Distance°from nearest well______________________ �+ ( ❑ Distance 3to nearest lot line--- -------•=--- -- ------- ------ - -------------------------------------------------------------------------- -•--------------------� Remodeling.and/or repairing (describe):---------�.1'Installing �'� __��n �`�d---I3D axUa.-:fit---____________________________________________________________ 1 _ t-a-t-��--�x1at-in ---g �-t-ask---�,x-t?� �o1id--- i'-� -------------------- ---------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- '---------- ------------------------------------------------------------------------------------ --------------------------------- _ _ ---------------------------------- �. �.z _ �" fhere y 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. ----------- (Owner and/or Contractor) (Signed) ____•____ -------------------------- --------- Owner—M r . ------(Title)----------------------- (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__ -------------------------=°• _ DATE- -- --_ DATE-----� - REVIEWED BY---------------------�-. S ------------------------------------ BUILDING PERMIT ISSUED l-------------- --------------------------------- DATE_- ---------------------------------- Alterations and/or recomrn ndations_______________________ ____ - -------------- ----------- r --------'------------"-----•-_----------.---_-----------------•--------------- 3: ----------------------------------- - ---- FINAL INSPECTION BY------ ------------------------- Date-- -- - J --• - -------------------------------------------- r SAN JOAQUIN'LOCAL HEALTH DISTRICT 814 North "C" Strew} 130 South American Street, 300 West Oak Street 132 Sycamore Street { Stockton, California Lodi, California Tracy, California Manteca, California