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FOR OFFICE U§�: Jc ..� APPLICATION FOR SANITATION PERMIT Permit No. ..a 1.... Z ---- ------- . ------ -- --------------------------------------- ------- (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 descl;bed. This application is made in compliance with qounty Ordinance No. 549. JOB ADDRESS AND LOCATIO e--- ACRTo1 ;F�------JR.D-------/Ii7 ----------- ` J Owner's Name---------------------P-Qlv------------ C-0-11111M�-1-v------------------------------- ------------------------------ Phone----••-------------------•-•----•--- _ y � c -------------------------------------------Address .F�.--...... --`-----1C -------6� --------- ---- Contractor's Name-------O-W- -Pq f�R--•----•------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms - Number of baths A---.- Lot size ---------------------------- Water Supply: Public system [I Community syst m E] Private �epth to Water Table-0- ft. Character of soil to a depth of 3 feet: Sand [ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan i Application Made: If es date__-..._ -.) No,R--'--' New Construction:_Yes ❑ No FHA/VA: Yes ❑ No Previous pp ( y .L+�`t.- w _ —_ _-_� 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---------------------------..-.-.--------------.. E(.��N� No. of compartments--------------------------Size-----.--------------------------Liquid depth--------------------------Capacity...-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation---..---------.._-.Distance to nearest lot line--------------.-. t14-6 Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material.................._..-..Depth of filter material----------------------- length..-.--...---....._-------_.._--.---------. Seepage Pit: Distance to nearest well-.--.6-57-------Distance from foundation---/ --------Distance to nearest lot line..--57— Number of pits------.ate_--.-...Linirig material-1? ':.K....Size: Dia meter--.3.3.----.......Dept h--------f. __.-1-fax r 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------------------------- --------------------- ------------------------------------------------------------------------•-------------------- Remodeiing_and/or repairing (describe)------ ---------------------------------------------------------------------------------------------------------•------------------------•--- ---------- /3 Z., 1s ---------------------------------------- ---------------------- --- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ 4 y I hereby ter t y that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- ---- _ -----------------------�-=------ =.__.- _-'=----=-- (Owner and/or Contracfor)- By:---------------------- -------------------------------------------------------------------------------------------------------------(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----------�-�------700 ----`------------------ REVIEWEDBY---------------------------------------- ---------------------------- ------------------------------------------------------ DATE-------- -------------------------------------------------- BUILDING PERMIT ISSUED------------ ------------ ------------------------------------------------------ DATE--r;----------------------------------------------------- Alterations and/or recommendations:----- ftD_ 1- �C_ �/ ± �1� ��' iN1��-4--------PI'S- .1_L_1-ii- --R�--------------------- --•-------------------------------------------------------------- ----•------------------------------------------------ ------------------------------ -----------------------------•-------------------- --------•----------------------------------------------------------------------- ------------------------- ----------- --------------------- ------- -- -- --- --------------------------------- ------------ ------------------------------------------ ----------- ----------------- -------- ---------------- ------------------ -- ----- - ------------------ -- -- ------------------ ----------- ------------------------------- ------------------- Date --------------:-- ' FINAL INSPECTIC3I-E�;.. Date = �` �_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:ellon Ave. •300 West Oak Street 124 SycamoTe Street 205 West 9th Street Stockton,California Lodi,California w Manteca,California Tracy,California F.P.C C. �'i