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FOR OFFICE USE: T -----I--------- _________________ APPLICATION FOR SANITATION PERMIT ...Permit No. ._��-�-"_- (Complete in Duplicate) --- ---- ----------- - ------ Date Issued _ / f`- " - --- This Permit Ex fres 1 Year From 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 c-orinpliance with County Ordinance No. 549. t {olS E_'.i_�4lfr�c� �O �! D 13 Q JOB ADDRESS 'AND LOCATION: N:h�a '"-_ Owner's Name --------- Vll - Phone ---------------------- i Address_ -------------- - - ----------- --------••------- -- ------------------------------------------------ Contractor's Name----cwivi�R:'--- ----------- -- • - - - -- ---------------- ------ - --------------- Phone,- ----•---•------•,----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units::__I----- Number of bedrooms _ ._ Number of baths ___I__ Lot size ____.1 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __9 ft. Character of soil to a depth of 3 feet: Sand 59/Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date____________________) No L_! New Construction: Yes ❑ No B' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ..•-11 Septic Tank; Distance from nearest well---- Distance from founa'ation � --_Vistance M teriaLpC.��7� No, of compartments_...,_ �L _.____$ize__, X�Q""�C- -__""Liquid depth__ CapaDisposal Field: Distance from nearest well._ _._Distance from foundation____.,f _____.. to nearest lot line___:S --------- .� Number of lines---------- - ----------------------Length of each line_--Y/,/42--- -------Width of french-------3_6-1------� Type of filter material---R-O-Cr�__,Depfih of filter material___.._ -_r.-.--.Total length-------------------0-0_ -- " Seepage Pit: Distance`to nearest well-------- -------:------Distance from foundation__...____._____.__.,Distance to nearest lot line----------------- ' 4' Number -�, ❑ Dumber of pits------------------ --Loring material Diameter-----------------------Depth----------------------- Cesspool: Distance from nearest well__-------_-------Distance from foundation-------------.......Lining material 171 _._.___.___,_"...._ -------------- Size: Diameter---_--------------------------------- Dept -------------- --------------liquid Capacity----------------------------gals. Privy: Distance from nearest well--------•----- ------ --- --------------------"-.____Distasfa nce from nearest building---------_____________________________ Distance to nearest lot line------------- Remodeling and/or repairing (describe):--------- -------- ------------------------------------ -------------------------------------------------------- ------------••-- t --------------------- - --------------------------------------------- ere y ti -- - -- - - -------•--------------------•------------------------------------------------------ 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 reuI tions of the San Joaquin Local Health District, r (SI"- �BY-- ------- --- - � .: and/or Contractor) ned) __----- ------ - - -------- ----- . f =_{Title)_------------ - ---- l---- l '(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i �{ FOR DEPARTMENT USE ONLY APPLICATION ACCEPT _ . -------------------------------------DATE------Y r 'REVIEWED BY f/ ` -- ---- DATE----------- ----- BUILDING PERMIT ISSUED--------------`------ -------------------------------------------------------------- ----------------- DATE----- - ----------- ---- ---------Alterations and/or and/or recommendationsi---,_ --- ----------------------------------------------------------------- .-�.�Zj tea, --------------------'--- ---------------------'-----------�---•--------- :r _..__.____..__..........._------------_------------------- ______________----------------------------------_---- ----- l i - ----- --- ---- - - ----------------------------------------------------------- -- FINAL INSPEC 1 ------- Date -------- y -6------- i 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.P.C q, �6 w;