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UK UFFICE USE: ................... �- :... ................. c2 ego 19.. APPLICATION FOR SANITATION PERMIT Permit No. .__ ... _. ./. (Complete in Duplicate) ................................... ------------ This Permit Expires 1 Year From Date Issued Date Issued .. d/_ ,o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install+he work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.............:27(* P Owner's Name--------------- --r--' A-•------- ......••--•-...-•-•-•••--•-.. ---•----•--•••--••----••• ...... ....................................+. .................. -�--------•---------------•------ .•------------ -----•-------•-•---......_ .._........... Phone..•--•-A rens { Pt3 ;31 sto0 =------t � ' ...........................................•-- •--•.....--•---:----........................ •Z?.A a P�urr3� &� � r �t Contractor's Name-_....:_.-'....:.......--------------------------------------------------------------� -- •--------- Phone_._......{JDwQ� Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court C❑ Motel ❑ Other ❑ Number of living•units: ._. Number of bedrooms':_)... Number of baths; ... Lot size'-.: _. Water Supply:. Public.system ❑ Community system E] Private Et Depth to Water Table .601 ft. Character of soil to a.depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam IN •Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes dote....................) .No [9, New Construction: Yes ❑ No ❑ FHA/VA: Yes❑ No ❑ TYPE .OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permuted if public sewer is available within 200 feet.)- . ,. _ _ Septic Tank: Distance from nearest well._...J�Q......_Distance from Touhdafion._.....AO AO!. -.Material.._.._-= $ "01%11 ....-.-._._"-••_•_.•_• 1 ' No. 'of compartmonts..._._. ....._._.. . Size-:---•-b --+If�._ �.. .. iuid depth....... :......._.Capacity--....... �; Q... fl Disposal Field: Distance from nearest rvell.....60M.,..-.Distance from-foundation.._..15t........Distance to nearest lot line----------------- ® Number of lines....._... t ......................Length of each line....Q-�..0-- - t-•--._.75aVidth of trenth.----....7 ._..._...__._.__.._." -Type-of filter material....._. - K s Depth-of filter matenaL_... ..___......Total length___......_ 60�...._.---•---•--...- Seepage Pit: Distance to nearest.well......1 -�-.DistancOrom foundation.......2,01 ..Distance to nearest lot line................. , ® Number,,of pits....... .I�......_..Lining.material._.._$$----:—Size: Diameter....._.33!R•._,...,.Depth._..'i�!•--- 1_, ......-----. Cedspool: Distance from nearest well...............,.-Distance from foundation....................Lining maaerial...................................... ❑ Size: Diameter.......................................Depth.................. ............ ._........_....__.Liquid Capacity.. i .........................ga s, . Privy: Distance=from nearest well...................... _. -_... Dist t:..::..._... .... .. ance from nearest building �....+r.- a_... ----...................................... ❑ Distance to nearest lof line..........:........... - emodeling and/or repairing (describe):.---•.------•-- y OQ *_ }...--•--...._...._.-------••--- ---.......-•...............•---•-----•----•---•-...-•-•- • I F. .........................-•----•-•-•••............_-•----.....---.. .......... -•............ .............. 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 rules and regulations of the San Joaquin Local Health District, *Ar..Parruh &-:$Iw IWe; (Signed) _.__......_.. --------------• -------.-...- (Owner and/or Contractor) By� C: � - - (Trifle)-----------..__.�Dt (Plot plan, showing size of lot, location of system in re a ion to wells, buildings, etc., can be placed on reverse side). ' a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---tr - �uS_... I. REVIEWED BY.._..... ....................••-- -------- .._.. t DATE._.. -- --------------- ------- BUILDING PERMIT ISSUED....................j.. ••---....... _ .-- ` .. -- v ......TE.........._ ............. -- Alterations and/or recommendations:--_. .!'`�)•!-(pS'-•--•-•-IS ... ------------ .................................-.................._...............---.............................._........--•--.......... ...-•--•---•-...........•--------•-- ................................................. .................................................................................................................................................. FINAL INSPECTION BY:.... 'r'=- ..._'.. - ...."------....-•------- ----- Date........ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harrelson Ave. 300 West Oak Street 124 Sycamore Street 205 Well 9th Street Stockton,California Lodi,California Manteca,California; Tracy,California aP.Ca, t