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z: � a o a - - --- -------------------------- -----------------------------------_______..__._____- APPLICATION OR"SANITAT'ION PERMIT Permit No. �� : ------------------------ ------------ -------- --------- (Complete in Duplicate) v y This Permit Ex ires 1 Year From Date Issued Date Issued _,S ,d Application is hereby made to the San Joaquin Local HealthDistrict fora permit to construct and in t&h^e work he e This application is made in complia iri described. e with County Ordinance No. 549. JOB ADDRESS AND LOCATIO _SlDIS--- !"M_ L -.------ 1 �--------'__- --1�1�---4�----- RAM ----��--- ----- Owner's Name----------}- ._ 4 Off L P---•-----------"--------------------------- -------- --- Phone-----------------------•-------••--- Address "E7_`j- ------ -O _ 1-41J., Contractor's Name----Q4VlR:--•-----••---- _-_--- --- -------------------------- ---------- ------------------------------------------------ Phone_.----------- -------•------- ----- Installation will serve: Residence`ffrApartment House Commercial I-- [I Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/-__ Number of bedrooms ' _ Number of baths _R Lot size __-_ _._-__ - ater Supply: Public system ❑ Community systeml❑ Private Depth to Water Table __>( .__ ft. Character of soil to a depth of 3 feet: SandGravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------it)No t ❑r'New Construction: Yes ❑ No �HA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No se-ptie tank or cesspool"pefmiffed`if•publii4-ewe-r'-is-availeble-within-200 feet:)' Septic Tank: Distance from nearest well------------- I Distance from foundation_________________ Material ---------------- -4E)MST+ A(&-No. of compartments....... -------------#-; Size Liquid depth_ ------------------ --.Ca Capacity------------------- _ _ .. Disposal Field: Distance from nearest well -- ------.-Distance from foundation--____- -____-Distance to nearest lot line_______________ �_ Number of-lines'_____________I--------------------_.. Length of each line-____2,5-.__'-____ Width of trench----------2� 0f `2� -- _ Typo of filter material____ i' _t __Depth of filter material____._�_�_ � ____-____-Total length------------- Seepage Pit: Distance to neare-st!well_.__- _ -______-._ Distance from foundation--------____________Distance to nearest lot lin- ~ ❑ Number of pits----------------------Lining material---------_--------...Size: Diameter----------------------Deptn--------------------------------- til ------ r , Cesspool: Distance from nearest well_________ ______ Distance from foundation__..-.___._.__-----Lining material--------.__.-..__-__.__ ------ ❑ Size: Diameter Depth-- ----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------- -- ----------------Distance from nearest buildin 9 -- Cl Distance to nearest lot line fa Remodeling and/or repairing (describ�e�:_.__-�-��-I-(�------.--�.�j.}C-�.}-----�-L��-----��C�{{��.IC}T��---•---- �11.�1_�� --•------------- ------- h.t�f}Tl_4f�/-----©-r---------Sinn-1 M�- 40 --------------------------------------------- ------------------------------------ --- -------------------------- --------------------------A------------------------------------------------------------------------------------------------------------------------------------------------------ ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I hwe prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, J.d rules and regulations of the San Joaquin Local Health District. (Signed --- .-€--------------------- -------- ----------------------------------------- ----------------------- ------(Owner and/or Contractor) of plan, showing size of lot, Iota tori of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- ©----------- - ------------------------------------ DATE---------- �=��-- REVIEWED BY - ------------ ----------------------------------------------------------------- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED --------------------------------------------- ----- ----- ------------ -- ------ --------- -- - ----------------- ---------------------------------- ---- DATE-- Alterations and/or recommendations-._____.___.--___--_-"-_- ---------------------------------------------------------------------- -- ----------------- --- --- ------------------ FINAL INSPECTI BY- 1 Date.------ ----- �.- ---L.""- -,�p�"----- --------- --------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street ` 124 Sycamore Street 205 West 9th Street Stockton,California F Lodi,California Manteca,California ` �i._ �_fv� Tracy,California F.a.c o.