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----------------- - -- --------------------------------- ------ ------------------------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------- ----- 0 (Complete in Duplicate) - ---------- ---------------------------------- - - This Permit Expires I 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 her6in'cleSCribed. ;2 5� This application.is__ma�dejn.complian'te with County Ordinance No. 549. t_3.75i ]�.. . - a 4 . - 2� 0 "s JOB ADDRESS• AND LOC-11014- Owner's Name---------------oi-l-Gova-ftz Phone - ---------------------------- -------- Address-----------------124 1 --p Contractors Name-----------------------Atitzow------R?xA—d w3,f_Y--------- ------ -------------------------------------------- Phone----------------------------------- Installation will 'serve: Residence B' Apartment House E] Commercial [] Trailer Court El Motel El Other El Number of living units: ---j--- iNumber of bedrooms Number of baths --i---- Lot size --A---A Wafer Supply: Public system El❑ Community system E] Private Depth to Wafer Table ft. t4 Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam El-`tlay E] Adobe F] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2r- New Construction. Yes ❑E] No F�— tHA/VA: Yes ❑E] No P., TYPE OF INSTALLATION AND SPECIFICATIONS-. IJ4 (No_sepfic_,fank or cesspoolp;rmiffed;rifpublic-sewer-is-availa6le-wifhin-200 fee+.). Septic Tank: Distance from nearest well---65--------Distance from foundation--.-1�epth -".-,-.-..MaferiaI-----PCR Ca 21- No. of compartr�ents--------- Sie-_A!_-_40'.6---------Liquid -------q�t------------Capacity-----ta- I Disposal Field: Distance from nearest well�kO_----f---- I ------------.-Distance from foundation----?W-q Distance to nearest lot line---4----------- ❑ Number of lines ------- Length of each line--------E-0---i;------.Width of trench_-9--------:1 Type of filter ma''ferial;,-f--- of filter materlal-----/-B-----------Total length___---__ ----------------- Seepage Pit: Distance fo nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.._.--_..____-_ } ❑ Number of pits------------------:---Lining material----------------------Size: Diameter-----------------------Depth---------------------------- Cesspool: epth---- -- ---------------Cesspool: Distance from nearest weJ1--------------.--Distance from foundation___________________Lining Lining maferial----------- -------------------- ❑ Size: Diameter_._- �;a .._ -------------Liquid Capacity------------------;' 5::� - ---------gal an ce fr'otr7t_,,7tsbuilding__-_.________..___-_---- Privy: Distance from nearest well__.._________________---------------------------Dist from t —- ------- ----------- El Distance to nearest lot line-------------------------- ----------------------------------------------------------------------------------------- --------I Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------- -- - -- - -------------------- i I --------------------- -------------------------------------•------------------------!---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------- ------ ---------------------------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------.;.... ---------- 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 an regulations of the San Joaquin Local Health District. (Signed)_-' -- -------- -- ------------------------------------------------------------------------------------------(Owner and/or Contractor) By------------------— - m-------------------- - -------------(Title)--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). ----------------- FOR DEPARTMENT USE ONLY APPLICATION ACC ------------ ---------------------------------------------------------- DATE------------------- REV , 4 -3je-6 7 IEWED BY 'PT, --- ---- ------------- ----------------- DATE---------- BUILDING ATE----------BUILDING PERMIT ISSU&)Z------------------------------------------------------------------------------------------------------------------ DATE----- A terations ATE-----Alterations and/or recommendations:------------ ---------------------- ---•------------------------ - ---------------------------------------------------------------------------------------------------------- ------------------------- ----------------------------------- ------------- I --------------------------------------------- ------------------------- - - --------- ------------------------ --------------------------------------------------------------------------- --------------- - -- -------------- -----•--•----------------------------------------------•--------------------------------------------------------------------.r----------------------------------------- ---------------------------- ......i---------- .L--------- ---------- ------------------------- ------------- -------------------------------- ------------------------- -------------•------------- FINAL INSPECTION ---- --- - ------- -------------------t- -------- --------------------------I---------------- Date--------- AN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.V.r O.