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FOROFFICE USE: ------------------------ --- ----------------------- - ------------------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. a '- --------------------------------------------- --------- (Complete in Duplicate) N This Permit Expires 1 Year From Date Issued � .Q Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#all the work herein described. This application is made in compliance with County Ordinance No. 549iq/j416C,5 ;eP. — cSO4t7�j/ OGF l JOB ADDRESS AND LOCATIONff��' 'cS4. — /WT SIA6744&/' T. e-��- --- ----�a C---•-•--•---- --------------------- ------------------------=-------------------------------------------------- Owner's Name-----'q 0Z_. -�u-�-Q - �b Address------------- 1pt �- t o x Z C-------- -------- y' Contractor's Name-------C-CPL_ .--I-F-i,- -17---------SEW C_-- ---5'TIGI o„ Phone--- Installation will serve: Residence .Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _'I_'*. Number of bed'roms _3_. Number of baths -,X-- Lot size 2_o____-/9 5---_---_-•______________ Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Table _SD ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No D• New Construction: Yes ❑ No;C FHA/VA: Yes ❑ No/ 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------_---------Distaned-from foundation--_-------------_ Material_.-.--_-.____...----..--__-._---____-.---___"-. ❑ 6A1g j Jf4 No. of compartments------ -------------------Size--------------------------------Liquid depth__'------- - --------------Capacity Disposal Field: Distance from nearest well..�QQ __Distance from foundation---3 --------.Distance to nearest lot line_-"'?' X1r��Number of lines---------------1---- --- g �' Len th of each line___--(.-Q Width of french___.---_., "y----------------- AP-0 Type of filter material-" S.. n -Depth of filter material------------fTotal length----_---------------- - (�--�--- Seepage Pit: Distance to nearest well--,---_--------------Distance from foundation------------------.Distance to nearest lot line------.--_------- 1 ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------------_-------Depth_-------------------------------- Cesspool: Distance from nearest well---------- ------Distance from foundation--------------- - -Lining material-...--__....----__..___-----__-----. El Y• ----------------------- ----- Depth-----, ---- -=---- ----s .,,,Liquid Capacity------- -------- gals. Size: Diam�ter w(31`1-------- De ot),. � , Distance from nearest building------------------------"-------- -__... Priv Distance from nearest weN---------------------- - El Distance tonearest dot line--'"=-- ------ --- ------------------------- --------------------------- -------------------------------------------------------------- 9 / repairing Remodelin and or Idescribe}- . 4X- CP; = -" '_ X/S JR/ --------- ---•--------- 1 ( I - ---------------------------l-------------------- ' ' - - - .44 ---------------------------_---------_--------------------- -------------�---!.-----r_ --------------- I hereby certify that I have prepared +hisapplicafion andhafthe work will"be donein accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. (Signed)- -' - - -- - - --- ----- - -- --- ---------- ------------------ Contractor) BY: .,. � ---------- (Title) (Plot plan, showing size of lot, location of system in,`, elation to wells, 6uildings, etc., can bie placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - DATE - _a_�_ l®. REVIEWED BY------ i DATE ----- BUILDING PERMIT ISSUED ---------- -------- --------------------------------------------------------------- DA-TE.-- Alterations and/or recommendations:_--------_t.-.-_".-- -------- -----------------------------------------------•----------------------------------- -----------------------•-----------•- -----------;=----- - }----------------------- ------------------------------------------------------- -----------------------------•-- ----------- - --------------- ----- I. f FINAL INSPECTION-BY-__ -- .- ... Date_=4 - ".'^~--~' L SAN JOAQUIN 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.F.0 4. F