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FOR OFFICE USE: ----------------------------------- APPLICATION FOR SANITATION PERMIT � - --- ----------------------- Permit No. __ f --------------------------------------------------------- (Complete in Duplicate) q Date Issued ----- ----------------------------------_-.--------------- -- This Permit Expires 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 h rein described. f This application is made in compliance with County Ordinance No. 549. /?TcA ' v Zo ,E t 7fi�o s�O l R E JOB ADDRESS AND LOCATIO «L/�:-r R®P [�,? C:� _ W------P �i 1 - �. rVOwner's Name------------ I� �-------------�A _ARVA-------------------------------------------------------- ----------- -- Phone------------------------------------ Address--------- ------------ T�±q J�-4�� ----------------------------------------------------------------------------------------------- Contractor's Name-- AJ-- 3� PT!C' i ----------------- --------------------------------- ---------------- Phone----------------------------------- ation will serve: Residence Apartment House Commercial [❑ Trailer Court ❑ iMotEl L] Other ElInstallNumber af.living units: __ Number of bedrooms_-.- Number of baths Lot size ------/400 --------------------- Voter Supply: Public system ElCommunity system ElPrivate Depth to Water Table _ _ ft. f Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Q'` New Construction: Yes ❑' No E] FHA/VA: Yes ❑ No JTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well---5.0-___Distance from foundation----1 ----------Materiiaal__CQ-N.C-aR..I-- -F,----- No. of compartments...._102-_. -------------Size--4/ Liquid depth ' /� Capacity--/;go®---- Dispcsal Field: Distance from nearest well._.V------Distance from foundation----AQ--------Distance to nearest lot line----------------- -C� ®� Number of lines-------------:Z----------------Length of each line--- -'Y-_ -_---Width of french------36------------------.-- ' - � Type of filter material-___RQ_C.�'N-_-_Depth of-filter materiaL____f�f_.___-_._Total length----------f�_f .__________________ �y Seepage Pit: Distance to nearest well------------_______a-Distance from foundation-------------------.Distance to nearest lot line__.._.-_______._ ❑ Number of pits---------- >._..."Lining mater'al-----------------------Size: Diameter-----------------------Depth_-----.-------------------------- 9 t Cesspool: Distance from nearest well-----------------Distance from foundation___---------------- Lining material---------.__--._--__.____-_-__-___.. ❑ Size: Diameter--------------Y- - - ----------------Depth-----�---------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest we'll----------------_.-°:_- ------------------Distance from nearest-building___I r------------------------------------- ❑ T Distance to nearest lot line-------- --------------- - ------- --------------------------------------, -------------------_------ - ---------------- Remodelingand/or repairing (describe)----- ----------------------- --------------------------------------------------- ---------•----------------#-------------------------------------- ---------------------------------------------------•---------------------------•------------- -----------•------- -------------------------•----------------- _ - ----------------------------------------------------------------------- _ ---------------------------------_-_------------------------------------------------------------------- --- -------------------------------------------- [ ------------ ------------------------------------ --- -- =---•------------------------------------------------------------------------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. -- - �--- r (Signed) ___._-.__-_(Owner and/or_Contractor) V _ _ _ .._.r J s Title .^: ---- --------- By---------------------------------------------------------------------- - -- --- -- ---------- - [. ' I ; ; o reverse - (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--------- .. -- --------------------------=---------- ----- ._ DATE 15 � REVIEWED BY---------------------------- ° ----- DATE-- --- --------------------- BUILDINGPERMIT ISSUED-1-,/---------------------------------------------------•------------------------ ---------- DATE.-------- ------------------------------------------ - Alterations and/or recommendations:------- ---------- --------------------------- ------------------------------ ----•----------------------•------------------------- w --------------------------------------------------- --------=- -------------------------- ------------------------------------ ------ --- ---------------------- ------------ -------------------- FINAL INSPECTIO ---• ----•-- ----- Date-------------- Ilq - ,,." SAN JOAQUIN LOCAL HEALTH DISTRICT r 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street If Stockton,California Lodi,California Manteca,California Tracy,California k r.P.C C.