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FOR.0FFICE USE; ------------------- ------ ----------------------------- ---------------------------- ----------------------- ---- ----------------------------_______________________.__.._________-_._..___..___.__._ APPLICATION FOR SANITATION PERMIT Permit No. .__,lr �° ___ ------------------------------- -- --------------- (Complefe in Duplicate) This Permit Expires 1 Year From Date Issued Date issued�iri ---- ------------------------------ -- - - 1Application is hereby made to the San Joaquin Local Healfh District for a permit to con struct.apd_install +he work heescrbed��0 This appl'cation is made in comp lanc-e�with Co"u�nty Ordinance No. 549. JOB ADDRESS AND LOC TION___-�--p�fLi � �fT� , ,,,� A�� r� RIS©�v ---- 1_- --D--------� _.. _ c .�_r ____.�= -F-------------•------------ Owner's Name '= - _ PM.P - , ----------- Phone-----•------------------------------ 1 � i ` ?Drr� Address i _._ �_ - A-�-•t•-O!..----- ---•---------•-----------------------------------------------•--- Tom- .= -- =Q=- `7 r Contractor's Name___ - __ _ __ Installation will serve: Residence ❑ Apartment House ��---,---•--- Phane----------------------------------- ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: __(_.-_ Number of bSd{ooms _ I / - - -_-- Number of baths -- -__-- Lot size -- _ C-� _�_�_ �_�----'----------------- 9t Wafer Supply: Public system ❑ Community"syste ''❑"Private E], Depth to Water TablTt. Character of soil to a cl pfh.of 3 feef: Sand Gt=evelE] Sandy Loam ❑ Clay Loam E] Clay ❑ Adob'e❑ Hardpan ❑ 1: Previous Applicafion Made: (If yes,date ._____ __.____..._) No +n "*New Construction: Yes Y 1�No FHA/VA: Yes ❑ No ❑ FH TYPE OF INSTALLATION AND SPECIFICATION$ {Na sepfic tank or cesspool permiffed if public sewer is available within 200 feet.J r W � , Septic Tank: Distance from nearest well---, � --Distance from foiindafion_--/0._____,__. Pe 'al___..>�1V O [ � No. of compartments,. Size_ -Xt - i quid dept__ �_____.�Capacity_,/ Disposal Field: Distance from,nearest well.__-'__Distance from foundation_____ ®� Number of line`s___. _ ,,; g � �---------Distance to nearest lot line_ic ___~___ � — ---------- �� t --- �� p ) Type of filter '`materlal__�Q_C-J.--De th of filter material_____ �� ) th of trenc----- A!_ ,---------- Seepage Y _. L'en th of each line____ __ I -t____-----+ Yp -- p --� Total length-=--------��--- -- Seepage Pit: Distance to nearest well---- -----------------Distance from foundation__________-_'!Distance to nearest lot line__._______-___--- " ❑ Number of pits--k------------------Lining material-----------1----------Size: Diameler---------------------Depth--------------------------------a Cesspool Distance from nearest well-----------------Distance from foundation------------ ------Lining material----------------------__________ � �' Size: Diameter_------I---------- ------------ ---De th------------I- .--------------- ---Liquid Capacity all p# Privy: Distance from neare'sf,.well------_-----___------------------------- _____.._Distance from nearest building-_.___...__-----------_-_-____..._.____..' I ❑ Distance to nearest loline-n - -..__._---- --- ------------------------------ !-------__-_-- ------------------------------------------------- Remodeling and/or repairing (describe):-- -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ - - ----------------------------------------------------------------------------------------------------------------•-•------------ --- -- - --' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count j ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. {Signed} � � «( --- - --------------------------------------------------------------------------------(Owner and/or Contracfo (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE.KLY APPLICATION ACCEPTED BY.--- ' --.------------------------- --------------------------- ----- DATE----- I REVIEWED BY-------- ------------ ------------ -------- ----------- DATE (©t" LILA RDATE BUILDING PERMIT ISSUED - Alterafions and/or recommendations:-------....... .-_.. --•------••------------•---------------------------------- -------- - --- ----------------------- --------- ------------- -- ---' -------------------- -------- Y -- --- ----------------------------------- ------------------------------ ------------- ` -- ------------ -------------------- ----- -- ------------ --- ---------- --------- � I FINAL INSPECTIO '_- --- - -- - Dater ----._._-- -- ` - SAN JOAQUIN LOCAL HEALTH,DISTRICT I 1601 E..Hasellon Ave. 300 West Oak.Streef 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California