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FOR SE: I - � _� N �.:. .. APPLICATION FOR SANITATION PERMIT Permit No. ,t " (Complete in Duplicate) 02 Date Issued ------- This Permit Expires 1 Year From Date Issued Appliati 'Arts�hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a "lica'tion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------•---//0-7------------ (O ,00U/c'e"V-4--m-,y Owner's Name---------13_0_, C-------------//.1Qw-------------------------------------- ------------------------------------ Phone------------------•---------------- Address----------------------------- ------ 1 cGi!TT �� Contractor's Name----------------C- 5K7-2,05--447b..--.....56G5/ / -----`r4t------------------------------------- Phone--------------•--•------ Installation will serve: Residence)K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ __� �' Number of living units: ____ Number of bedrooms•_�r_ Number of baths -1------ Lot size __g-5--------------------------_------ Water Supply: Public system ' Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: (If yes,date....................) No'K New Construction: Yes ❑ No ' FHA/VA: Yes ❑ No ' 1 { 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 _________________--.__________..____._.__-_-_. ❑ �+ No. of compartments------------ ------------Size--------------------------------Liquid depth--- ----------------------Capacity------ ---------------- Disposal Field: Distance from nearest welloQaG---Distance from foundation------ _Q........Distance to nearest lot line...-.- ___�_____ .- ' n Number of lines-------------I-------------------._Length of each line------------2.0 _ _ Width of trench-----------Xy-----------____-- OL-AType of filter material____ Depth of filter matsria!____.___1 '.i__._Total leYngth_________ ___________ Q!� --------- Seepage _______-See a e Pit: Distance to nearest well 0-6--__D�istance from foundation_= _ Z�_ ______.Distance to nearest lot line 4 Number of pits--------I---------.--Lining material---1§"aJ&O-1lC..Size: Diameter....._-...C-0 4_._--Depth__. - - .- --?.�---.-----�---___--- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------..Lining material---------- -_;---------.- I ❑ Size: Diameter--------------------- .-----Depth------- -------------------------------------Liquid Capacity-------------------------r--gals. a Privy: Distance from nearest well_________________-___ y_--------____._.._Distance from nearest building......---- ------.____-------------...___. w ❑ s... -S Distance to nearest•lot line. ------------- --------------------------------------- ---------------------------------- ----------------- -F = Remodeling and/or repairing (describe)---------------ADD......--'Tc ----4FXIIV- ---------5��E�-------•---'-_-------•------------------- �. ar p ( � - _________________________________________ _________------------------------------------------------------------------------------------------------------------_---------------------_------____-------_----------------------- I hereby certify that I have preparled this application and that the work will be done in accordance with San Joaquin County ordinances, State laws;`and'i•ules`and regulations of the San Joaquin Local Health District. 42-p--- (Signed)-------------- -.r------=----------- -------------------------------------------(Owner and/or Contractor) 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 s APPLICATION ACCEPTED BY----------- _ ---------------'------------------------------------------------------ DATE-,----.. =T REVIEWEDBY------------------------------------------------------- - ------------------------------------------- DATE---------------------•------------------------------------ BUILDING PERMIT ISSUED.-----;. ----------------------------- ---------------------------------------------------- DATE---------------------------------------------------- Alterations and/or recomm dat•ons:.f----------- -- i•- --------------------•---------------------------------- ------------------ p ----------- ------------------------------------------ ----------- ----•-------------------------------------------------------------------------------------------------------------------------------- ------------------•- '--------- i •-------------------------------- -------------- - -------------------- -------- -------------------- - ------------- 11 f -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- -------------------------............... FINAL.-INSPECTION�BY:-- f - µ-----------------------...M ., Date - .- 3l1 S . ---------- . --------------- -------- - \ Ilk - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RCO. -4 , a u l