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FOR OFFICE USE: --- - -------------------- ------ ---------_-------_--_-----_---_----------------_-_ APPLICATION FOR SANITATION PERMIT' Permit No. -- ------- ---- -------- (CompMein Duplicate) 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. This application is made in compliance with County Ordinance No. 549. 2515'^3to— JOB ADDRESS AND LOCATION-.!_�'`*S°'1"1C1�� U(= ---N- .._/JIl� �__�f��i-- ----� �.__-75----------------`---- Owner's Name_ lks__,1 Qa-u-S,------------------ ---------------------------------------- Phone---- ------------------------------ Address----------------------------------------------- --------------------- Q �} ------------------- Contractor's Name--�[�Rw---I�b C?---1_S1EFNf��---------1-:P. x � _ �� ------------------ Phonel3S' /t T 7 � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel F] Other _�____ Other Number of living units: Number of bedrooms -0--- Number of baths _�_____ Lot size ___---1J_'Z-_�' �------------------------------___--_._ Wafer Supply: Public system ❑ Community system ❑ Private [3 Depth to Water Table _"`')_.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam [] Clay ❑ Adobe•-E�- Hardpan Q Previous Application Made: (If yes,,date--------------------i No [� New Construction: Yes ❑ No (—FHA/VA: Yes ❑ No t 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-----------------Distance from 1�' x15n . foundation__-_---__----. Mteil_-.---..-__--____-- .___- -..----------_-.-__-_ No: of compartments-------------------------- depth ____ _-----. CaPacity----------------------_- Disposal Field: Distance from nearest well.,.__4�--- . Distance from foundation-_ O...._._..Distance to nearest lot line--_57 � ` t15r�acYi Number of lines--------- ----Q- -------:-------Length of each line--------8.0------- ------Width of trench------- - --------------- ---- Type of filter material-r5._f4 ______..__Depth of filter material------JX...........Total length---------1L ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------._---------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter__.--------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation ----------- --__.Lining material---------- --------------------------- IL _ --`. _ Size:-.Diameter---------------------------------------- De th_-- ._---- - - - --- Li uid Ca Capacity_ - ----- __ a Privy: Distance from nearest well--------------. -__-__ .--- Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----------------------------------------------•------------------------------------------------------------------- 1 i4 Remodeling and/or repairing (describe:.--------- -------------------------------------- } 1 -------------------------------------- -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------ 1 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) .Ptd, (Title) --------------- ------ -- ---------------- (Plot plan, showing size of ot, ocation system in relation to wells, buildings, etc., can be placed on reverse side}. 4� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDgBY_ _._ -- --------------------------------------------- ---------------------- DATE----- -"dS-� --------------- --------------- REVIEWEDBY--------------------- --------- -------------------------------------------------------------------------------- DATE------------------------ ------------------------------,---- BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------- DATE---------------------------------------------- Alterations and/or recommendations---- ------------------ ------=--------I-- -----------------------I—------- --------------- ------------------------------------ -------------------- ----------------- ---------•------ --------------- - ------------ --------------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------•----------------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------ -------------- ----- - - - ----- ---------------------------- ------- ---- ---------------------------------------------------------------------------- --------------- I FINAL INSPECTION B .. Y-17S'AN - --- ------------------------- Date-------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California _— Manteca,California Tracy,California i F.F.CC.