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FOROFFICE USE: 6 - ��a --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------- ------- (Complete in Duplicate) / Date Issued This Permit Expires 1 Year From Date Issued Z - 1-70-/-7 Application is hereby made to,the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I � r ,2,24P9 s, 7�?n o E W �;I p g ! JOB ADDRESS AND LOCATI .NJI l YF ----- -)--------, .. Owner's Name--------- ,- 014-----D N----- s—c-H----------------------- ------------------- -' -- -- Address------------- ..:��. Q --------�17-------Y------------R-1r -------------------------------------------------------- Contractor's Name------0VVA_4F-.K--------------------- ------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ['-�_Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms _. -- Number of baths I__ Lot size ---A_4��. �_� ____________________ Water Supply: Public system ❑ Community system ❑ Private ©-'Depth to Water Table Character of soil to a depth of 3 feet: Sand,21--Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote---.----_..........J No [ New Construction: Yes ❑ No 0--FHA/VA. Yes ❑ No [' TYPE-OF INSTALLATION AND SPECIFICATIONS: - " -W ._-.- - - - '—";--• - - _ - ' ' ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: _ Distance from nearest well Lam_____Distance from foundation..../0-__.___Material----t_�D_>:'VO0—b_____________ No. of compartments_____ ________._.Size__ __ _ -_x—_Liquid depth_____ ___._Capacity-___� C_�___- N Disposal Field; Distance from nearest well----%5_r-----Distance from foundation_______f __.._Distance to nearest lot line____S it Number of lines-----------/-----------------___Length of each line___:__4)0._.F........Width of trench------- ____ ti '0P Type of filter material,-� G !;!%__Depth of filter material /-..._._____Total length_____-_____lob?_________________ (� Seepage Pit:' Distance to nearest well---------------------- from foundation-----------.........Distance to nearest lot line-...______..___._ ❑ Number of pits----------------------Lining material--_-_-----------------.Size: Diameter-----------------------Depth--------------------------------- Cesspool- Distance-from nearest well-----------------Distance from foundation---_____---------___Lining material-------..._.-_..____.______-_El ___.___ Size: Diameter----------------- --------------------Depth-_ _--------- _ --- _ _ _ _ ---------.Liquid Capacity ---gals. Privy: Distance from nearest well-._.____-----_-----------_----------------------Distance from nearest building----------------------------___---- -_. ❑ Distance to nearest lot line line--------- -------------------------------------- -------------------- Remodelin9 and/or r�Pain (describe):--------------- --------------------------------- -- -------- ' ------------------'-'-•--------r------------- --------------------------------•- ----------------------------------- 81E1N-AA''- hE8l1_:T`----- -----F 1pQ------1- Stl .4 ------------- �-Y LL'l S� � S1.F_P -------T_v------ ------040----- -R - ►° ' 0 --------- -T------- -- 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. (Signed)---------- --•---------------------------------------------------------- ---------------- ----- --------------------------------------------------------------.(Owner and/or Contractor) ly-------------------------------------------------------------------------------------------------------------------------------------(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...... . O----------------------- ----------------------------------------- DATE------ = - REVIEWED BY - BUILDING PERMIT ISSUED----- ----------------------------- ;---,--- ----------------- DATE---------------------------------------------------------- ' Alterations and/or recommendations:_____"'!""__. ""'`_ r ----------- ------------------------------------------------•--------------- ------------------------------ ----------------------- ------------- --- --------- ---------- k-- - ---- FINAL INSPECTION_$Y � /�I --- '7 Date----------------- _^1_ . 15. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1loxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California