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t-UKUl-HU USE: --------- ::.------ -- --------------------------------- ' / -------------------------- ----------------------- APPI-KATION 'FOR SANITATION PERMIT Permit No. _/..� - - ---------------------- ---------------------------------- (Complete in Duplicate) / = ---------------- Date Issued�..' _ b- S -------�--- - 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. a yt,'f JOB ADDRESS AND LOCATION ,f1 .s,S 2-. ------ ---- r / � Owner's Name a 1-' -•---- n Q ._.�a. __z' �ts:�_ c Phone---------- ------------- Address------------ --------.---- Address------------ ©a< ft_ � 9 -----------•-� ��e^�t�rxr �f11 ------------------Contractor's Name -- 1�----------- ------------------------------------------------- ----------. Z-7-� Installation will serve: Residence Apartment House ❑ .Commercial ❑ Trailer Court ❑ Motel Other E!I-- .` Number of living units: ------ Number of bedrooms -------- Number of baths J_- Lot size -------ffe0-';5 Wafer Supply:, Public system ❑'Community system ElPrivate F1 �_ Depth to Water Table /r___'rft. Character of soil to a depth of 3 feet: Sand Gravel _ -. r. _ ❑ ❑'. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 93' Hardpan ❑ Previous Application Made: (If yes,date----- ..............} No New Construction: Yes No ❑ FHA/VA: Yes ❑ Nog, TYPE OF INSTALLATION AND.:SPECIFICATIONS: —(No septic tank or'cesspool p rmitted if�public-sewer is available within 200 feet.} Septic Tank: Distance from nearest well-5-6---------Distance from foundation_-_-/a- v--iC � — Er No. of compartments-------- ---------------Size;--- 'f.K�f?�-- ------Liquid depth-------IV---- - Ca aci- IL v O Disposal Field: Distance from nearest weil_SQ_------•_Distance from foundatAon_1 10__ _._..Distance to nearest lot line._. ___-,_ -- [ Number of lines-------- ----/-�-----------------Length of each line- _-_--j- o--:''.Width of trench_____Z--� t_____--- Type of filter material__--�1.E4� _------Depth of filter rr: terial---- f- -��---=_'-.Total length_._---/-� O. - ---------------------------- 1 r ,- _ Seepage Pit: Distance to nearest well....I-----------------Distance from foundation--------------------Distance to nearest lot line-_._____.___-_-_ 9 1__Lining material_______....-_ - r ❑ Number of pits-----------------f -------Size: Diameter-;--------- --------Depth--------- ------- '_ Cesspool: Distance Jearest well_________________Distance from foundation___--------- .Lining material--..___..._._._____.____. V' ❑ _ Size: Diameter:. ---- -- -----Depth------- --- .Liquid_Capacity.. b . ., — . .�-m ,. � --- ---- gals.- 4 Priv_y7 Distance from nearest well_________________.______ -._ .___------Distance from nearest building i e 9 ❑ Distance to nearest lot line ----------- ---------- r Remodeling and/or repairing (describe):_----------------_- t - - ------ ------- - ------- ----- - ----------- _ --------- 3 - ----- ----- ------------------ --°--------_-------------•-------•--- --------------- -- s ' I hereby certify that Ihave -=p------------------pP---------------------------------------------------------------'=---=------------------------------------------------ -----j-------- Y Y pre ared this application and that the work will be done-in accordance with San Joaquin Counfy ordinances, State laws, a drules and regulations of fhe an Joaquin Local Health District. 4 1 (Signed)-------------- + -- ' (Owns --, -r �.�w�r..---By�----�--- - - w(Title' . =d/or��r - - ---- ------- ------ -- ----- — __ 0 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can beplaced on reverse side). ' --, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_----------- ------------------------------ ATE._ f REVIEWED BY------------ - ------------ v � - - ----- -- -- _ DATE----- - _ - BUILDING PERMIT ISSUED ------------------- • ----- ?V- �! DATE-------- ----------- Alterations and/or recommendations:_____________________________ _ I --------- - ----------------- -------------------------------- - -------------- ----------------------- ---- ----• I ------------------------------•---- - ------ ---------------------------------- -------- -------------------------------- -------------- ------------------ ---- ------ ----------------------------------- --------'------- ------- ------------------ - ----- - J < e FINAL INSPECTION BY:...... "` "� Date t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street - 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cp.