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FOR OFFICE .USE: -------------------------------------------------------- _________________________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. 4Z�:. _ Y ---------------------------------------------- ---------- (Complete in 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 complia ce with County Ordinance No. 549. JOB ADDRESS AND LOCATIO -------4A...'T�}_F�Q-�-------�--1-�-. rZ---�Yt�t� 0 � I_I Q r Owner's NameR -_�_ O!V_ l _R _ -�1 --------------------- -------- Phone------------------------------------ Address-..-....... -------------------.-..------------Address------------- r -------------- ------ --------IWAWT Q_�---------------------•-----...._.---•------------------------._...---- Contractor's Name-------jaq R - ------------------------------------------ Phone----------------------------------- ---- -1----------------------===---------------------------------------------- l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___._ Number of bedrooms -2—Number of baths I___ Lot size _/7//G-R -A__�i_-I-.-----_.._.--_-------_ Water Supply: Public system El Community system El Private e Depth to Water Table -_Q - ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Madi; (If yes,date--------- 1 N8 J?" New Construction: Yes.�o R?'_"'EHA/VA:_Yes ❑ No..2j---_ TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well %0 Distance from foundation___,10---------- Material__..a AICRF?" RF C No. of compartments---- . ------- Size__3 x_'7_X._5--._ _Liquid depth_.7 .7-1, ___._..Capacity----87 f Disposal Field: Distance from nearest well. Q__. _Distance from foundation__.10_e--------Distance to nearest lot�lifne---- E ___S.__._.__. E,1(�p'rlIV6 Number of lines----_-_____I_._._.__..r----__..__Length of each line_____�,lQ_-_-- Width of trench.____.2. `"_�__-__-f_-__- Type of filter material__ Q .___Depth of filter material -___/�._.--____.Total length______________J,!tv_________--__.- Seepage Pit: Distance to nearest wef!-------?___ f--------Distance from foundation--------------------Distance to nearest lot line----------------- El ,Number of pifs----------------------Lining material-----------------------Size:,Diameter-----------------------Depth.------------------------------- Cesspool: Distance from nearest well-----I-----------Distance from foundation-______---_----____ Lining material---...._.____..____..______._____.___. ❑ Size: [diameter. -----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-._.- __________________________________________Distance from nearest building___--__---.--_-_-__-_____________.___..._. ❑ Distance to nearest lot line-------- - ---------- ---------- ---------- - ------------------------------------------------- ------------ ----------------------------- Remodeling and/or repairing (describe)---------- --------------------- - - ----------------------------------------------------------------------- ------------------------------------------ ---•-------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------t- --------------------------------`---------------------- I hereb tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t law , anfa- les and reg ations of the San Joaquin Local Health District. (Signed)---- ------ -------------------------------------------- ---------------=-----------------"--- -----:--(Owner and/or Contractor) By:--------------------------------------------------------------------------- ---------------------------------------(Title)------------------=------------ ------ ------ ........ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -- – FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- `Q---------------------------------------------------------------------- DATE--------- , REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE-- ------------------------- ------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------- ----_-------------------------------------- DATE---------------------------------------------------------- -- Alterations and/or recommendations---------------------------------- --------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- -•----------- - - ------ ---------- --- ------ -----•---------------------------------------------------------------------�---- --- --------- ---------------- l �C Date FINAL INSPEBY.- SAN 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 F.F.0 a.