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Kurt-lk-t Ubt, ----------------- --------- ---------- ------- - --------------------------- ---------- -------- ------ APPLICATION"FOR_'ISANITATION PERMIT I Permit No. ------- ------- -------- ---------------------------- ------t"- _P (Complete in Duplicate) --------------------------------------- -A This Permit Expires 1 Year From Date Issued Date Issued -------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. with C iWrzl�hance No. 549. compliance wr 1 1 JOB ADDRESS AND LOCATION- e Owner's Name------ OF ------------- Phone------------- Address ----------------------------- ----------------------- 6- ----------- oe Contractor's Name_____._..__ ------------- ------------------------------------------------------------------------- Phone ----------------------- Installation will serve: Residence Apartment House 0 Commercial F-1 Trailer Court F-1 Motel El Other El Number of living units. Number of bedrooms-1__- Number of baths oI Lot size _04V74405,0- Wafer Supply. Public system ❑ Community system C] Private 2;0'15repfh to Water Table /4--ff"' Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loam RI-,C*'Iay Loam [] Clay E] Adobe C1 Hardpan Previous Application Made: (If yes,date..._..---._-_._.-.-} No 2qoo? New Construction: U?I�o El FHA/VA: Yes 29.- No E] _ — �_ . Yes �} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well tIC1111,----- Distance �om,�fwdation Maferial-e.&A-I---------- -------- No. of compartments....111--------------- z etQ�-0-0 ----Capacity/2.0 ----- Disposal Field: Distance from nearest well_-4;r...Distance from foundation_`-. ------Distance to nearest lot Iine___#7_-` Number of linGs_417. Length of each line__ t ---"""-------------rWidth of french-07 Type of filter material Depth of filte ;�r------------- r material-_...... ___Total length---0?-,W----- Seepage Pit: Distance to nearest well-------------- --------Distan(fe from foundation-------------------Distance to nearest lot El Number of pits----1------------I--- i Linng material-----------------------Size: Diameter------------- 11 ----------Depth--------------------------------- Cess pool: Distance from nearest well------ ----------Distance from foundation -,-----------------Lining material---- ------------------- El Size:1*Diameter------ -------------------------------Depth---------------------------------------------------Liquid Capacity------------------ ------------ -----gals. Privy- Distance'fPom nearest well -------------- Distance from nearest building------------------------------- -------❑ -- once to neaI4s7 lot line__.--_._- ------ ---------- - ---- ----- ----------------- ------------------------------------- Remodelii�g nd/6-r�;Va ---------------------------- ------------- ---------- ----------------------------------------------------- ----------------------------------------------------------- ------- ------------------------------------------11--------------- ----------------------------------- ----- d------------------ ------------------------------I------------------- ---------------------------------------------------------------------------------- ---------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- -t I hereby certify that I have prepa"red this a'0pIi6aafi8aiFdn 'fliaFfWe work will be done in accordance with Son Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin.1ocal Health District. (Signed)-- I-------00-0-6-r1 4;�Zo'_ ---- ---- i �j -------------------------- -----------tE)qwvmmm=j&r Contractor) y:-----------------------------------------I -------- - ---------------------- if le)4�._rlp�-10_4� -- - --------------- -------------- 'or (Plot plan, showing size of lot, location �)f system in tion to wells buildings, etc., can be plaI on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ---------- --- REVIEWED BY.---- I----- -------------------------------------- ;I' Ad -------------- "t------------------- -------------------------------------------- --------------- DATE-_------ BUILDING PERMIT ISSUED_".----------- ---------------- DATE ------------- ---------- Alterations and/or recommenclations:_" ----------------- ----------------------------------------- ------------------------------------------------------ -------------------------------------------------------- ------- ------------------------------- ----------------------- ---------- -------------- ------------- ---------:--- ------------------------------I-------r---------------------------------------------I----------- ------------I----------- ------------------------ ------- ---------------I------------------------------------------- ------------------ --------------- ------------------- ------------------------------- ........ ------------_----------- -----------------------------------------------------------_------- -------------------------------- ---------------------------------- ---------------------------------- ---------------------------- ------------- - ------------- ------I---------------------------------------------------------------------------- -------------------------------- FINAL INSPECTION By:..IAI- - - - - --1 SAN JOAQUIN,LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 1 11 124 Sycamore Street 205 West 9th Street ji Stockton,California Lodi,California M n"ia California Tracy,California F.P.Co.