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FOR-,QFFIG5,USE: APPLICATION FOR SANITATION NITATION PERMIT Permit,No. _.,�.........-- . ----111111 11-1111-- --- -111111 11.1111-- _ (Complete in Duplicate) - ------------------ �{;�0�� Date Issued --'�'- s ._ �...�---- -._ This Permit Expires 1 Year From Date Issued �� _ 0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work hedescribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------ H-_ P-----'-_1>_-=----�Q .......1r5! r ! �� -/-( �� ' Owner's Name---------- -------------- ----------------------- -------------- Phone ---1- ----------- Address-------.------- ..T. - � _ 1` '- ----------------------------------------------------- 1 Contractor's Name-WCA-----5-F---X1-4-----�`�-�_I��G-Imo---_--1111-- -1111-- -- -------------------------------------- --- Phone.---•---•------•-•-----------•--- Installation will serve: Residence El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1e7C&O 3---- Number of baths l� --� s _ Lot size -------��.�__�C.._2_��-- Number of living units: _______" Number of bedrooms // """"""""""" Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table .16- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El Clay Loam [I Clay ❑ Adobe ❑ Hardpan C] Previous Application Made: (If yes,date-----------_--------) No New Construction: Yes V?-<o ❑ FHA/VA: Yes ❑ No a-- TYPE OF.INSTALLATION AND SPECIFICATIONS: s-_:_ �- {No septic tank or cesspool permifFed if public sewer is available within 200 feet.) -� Septic Tank: Distance from nearest well---_✓__0_._-Distance from foundation---/Q_-______-Material--- ------- No. of compartments__.___ _____________Size__` - j -X_5_,___Liquid depth------��.-------Capacity--/;go -- Disposal Field: Distance from nearest well____...?_0_-Distance from foundation---/0--_------Distance to nearest lot line-5_______ Number of lines----------- ----- - Length of each line d`- a�.Width of trench_------ _.__-_.I---------- 4 Len t? Type of filter material__iR_0CA__Depth of filter material____._ ---+ Total length_____________-//_0------_---_----- Seepage Pit: Distance to nearest well-------------________Distance from foundation------------------- Distance to nearest lot line_____--.________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------.-----Depth---------.----------------------- ' Cesspool: ' Distance-fr`om nearest well-----------------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-- --- ------------------- -------------------------------------------------11-11------------------/Cf Remodeling and/or repairing (describe): ---------- -------- - ------ ------------------------------------------------------ ------111111 11---•-••---1111-- -------------111111 11---1111-- -----------•-•--------•-----------------1111-- 1 111-•--------1111-- ----------1111-- - --1111-- - w ------------- ---1111-- -----------------------------------------------1111-- ---------1111-- ------------------------------------------------------------1111-�1111- -- = -------•---------------------------------------------•----------------------------------------------------- 1 hereby certify that I have prepared this application and-that the work will be done in accordance with San .Joaquin County ordinances, St laws, and rules pin r uI tions of the San Joaquin Local Health District. s ; ..______Owner and/or Contractor 5i ned � � - G� ��1 -------------------------------------------------------------- ( / I ! [ g 1111-- - - = - - -1111-- - 11 _ ---- ='_-�::__�_._---J-------___:...-----------111111 ------------------ ------------1111-- ----------1111-- -----(Title)--- ..-----_ - --1111-- -------------1111-- - •------1111- (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____._- _T1 "F-___.__. ------h { S� --ti---1111-- -----------1111-- DATE-------�-�--��--��-111111 11--1111-- i --------1111-- - - .. .._... r - REVIEWEDBY-------------------------------- ----------- --------------.-------` ------<---- - DATE BUILDINGPERMIT ISSUED"-----------------+------------------------------------------------------------------------------ DATE----------a----------------- - - -------------- -------------- Alterations and/or recommendations:+ -----------------_-------- -------_---- - ---------------- ------------------------------------------- � - lK__.T7 97 -----4110----- S-- - --------------------------------------- ------------1111-- 111 ---------------------------------------------------------------------------- 5 -------1111-- - i FINAL INSPECTI Date_...._-3 ""-�3 -V-3 _.. .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Av*, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.