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FOR OFFICE USE: �. Permit No. .. . ! - - � �- ----=-------- XIA APPLICATION___ -- 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 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. 3�a _ JOBADDRESS AND LOCATI N-------------------------- -• ------`--.'-----l.C/--------------- --- ----"'-`-------------------••------------------------- --•----------------------- Owner's Name -------- Phone.��_`S.r__8` ��- - _= Address C �-s3_ .. � - - --- --------- ------------------ ----------------- Contractor's Name________ _____ ______ -/ p-3/�fl� ----- ----- Q�C.�t .Q.�,�---- . •.-- Phane Installation will serve: Residence aA-partment House ❑ Commercial E❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _/__ Number of bedrooms __'Number of baths __/_ Lot size 5X-- -- ----------------------- Water Supply: Public system [!T�Community system ❑ ` Private ❑ Depth to Water Table f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a-lHardpan ❑ Previous Application Made: (If yes,date_---------_---------] No P4---New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: `° Distance'from nearest well�14X.$L-__Distance from found __ ation- X v__......Material---- ----------------..------- ryry No. of compartments___.1eR_1---------------Size-_ -/__-._-___.Liquid•,depth.____��- Capacity__.li.�- .-- Disposal Field: Distance from nearest wellDistance_f.ram.foundafion`7,l0........Distance to nearest lot line_►--------- - • Number of lines--------L---- ----- ------_---Length of each line'---- -------------.-.Width of trench.-----v7--3/------------------- . - De th of filter maferial_-_1 --g-%r"--Total'length___.-----____--_=------- -------- Type of filter material__ p Seepage Pit: Distance to nearest rot f ndation___D�_. _�__.Distancg to nearest lot line__i__ ------ Number of pits------ -----------Lining material_ _.Size: Diameter----e�_r _.___...___Depstn;-.---4 ----------------- 0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------.----------- y ❑ Size: Diameter--------------------------------------Dept h------------------------------------•.----------`-----Liquid Capacity- -------------------------•gals. V 'Privy: Distance from nearest well_-,--:-----------------------------------------Distance,from nearest building------.---------------------------------- El Distance to nearest lot line-------- --------------------- ------ --------------------- - --------'--ti---------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------- --------------------------------------=--------- ----------=------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- ---------------------------- -----------------------------------------------------------------,--------- 4 ------------------------------------- ----------------------------------------------- -------------------------------------------------------------------=------------------------ -------------- 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 r les an regulations of the San Joaquin Local Health District. t e [Owner and/or Contractor ------ ------ y {(5t ned} Title)BY' - --- i -------------- (Plot plan. showing size of lot, location of system i elation to wells, buildings, etc., can be placed reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- . . ...... ---------------------------------------- DATE--------_aeX4- 5----------------------- _REVIEWED BY------------------------ ---------- -------- ----------------- ------------------------- ------ DATE-------------------------------------------- --------------- '*BUILDING PERMIT ISSUED-------------------------------------------------------------•-------------------- ------------------- DATE---------------------------- ----------------------------- r Alterattioo/,;an /or reco m ncItions:. ---- ---------- --------------------------------------------------------------------------- -'-----/� ---- �----- --Q'�-- o-J-�-�------ ---------------------------[�-----------------•----------------------------------------------------------- Q.!/-_K._i. ._•__---..._---__---.-_•----------------------"-__"___--_--.-.-----_-._ ------------------------- ----- ----- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY------- �-...____------ ------------- ---------- Date--- y -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:elion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.