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FOR OFFICE USE: --------------------------------------------------------- y ------- -- - ---- ------ ---- ------ -- - - ---------" APPLICATION FOR SANITATION PERMIT Permit ------- ---- ----- -- - --- --- -- (Complete in Duplicate) c -- - - - t Date Issued ---- "" This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for ai permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I',� E7rjC , JOB ADDRESS AND LOC ON-------/ -F? I1 C', ... _._..50---------�/-�t TPU-�`------- RD- --------- Owner's Name------------------ H14 '-----<ENT-R ------- ------ Phone------------------------- ........ 13 Address - 1" 2 -- ------ C�---LIr�J/ ------------------------------------------------------------------------------------ Contractor's Name__6JW_/'_EZR-'-------------•-------•-•-----•-------------- I -•--------•-•---•---•-••-------___-_______--- Phone------•----------------------------� Installation will serve: Residence Apartment House ❑ Commercialj ❑ Trailer Court ❑ Motel ❑ Other ❑ I� �� Number of living units: ___I____ Number of bedrooms•___ Number of baths �_.-_ Lot size _ --------170 Water Supply: Public system ❑ Community system ❑ Private �epth to Water Tab e Z5__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date____________________1 No New Construction: Yes Ejj�o ❑ 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: Not of com artme tst wel�.�� DZeance fro fo p undafion__-.�-------------MateriaL_ R_ T _.-_.__.F p ----------------- 3_x_ X__ _Liquid depth-----��2-------Capacity-----19 1�____ Disposal Field: Distance from nearest well"-.5-t' ----Distance from foundation__ _ /�_-__..-_Distance to nearest lot line____57 ..... Number of lines"" -----------------_______Len Length of each line______.__ t �� [� g t Width of trench �� Type of filter material__,��__C.6.---Depth of filter material____ __ ____--"__"___Total length--------- _-__-_--...____v1 t Seepage Pit: Distance to nearest well--_,/Q_0-------Distance from foundation----!V.........Dista e to nearest lot line"___`�?�~.,_ IF Cesspool: Distance from Weare t�wall-"__-_--;g -__Distance from {off -Size: Diamet __ __ _____ ________ epth______/.��_._ _____`-_______.... Number of pits--------- " Linin material_ _ QCK undation------------------- fn'fnVmaterial....--------------------------------- ❑ Size: Diameter....-------------- -------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. , ? Privy: Distance from nearest well----------------------------------------------!!;_Distance from nearest building--------------------------_---o____-_-__-. ❑ Distance to nearest lot line---------------------------------------------- ----------------------- =--------------------------------- ------------- (a Remodeling and/or repairing (describe:------------11-PD--------51F- U111 �/_ _- -?Q 5T ---- --------_EYT_s k/_C ' ----- P jr --------------------------------------------------------- ---------------------------� --------- r - ----------------------------------------•-------------•--- --------------•---------------------------------•---•-- -- •----••----------` - •------ 4 M I 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 regulations of the San Joaquin Local Health District. (Signed)------- -- ----------- -------------------------------------- ------ ----(Owner and/or Contractor) By ------------ Title Plot -plan, showin size of-lot, lb;—cationn of's'*stem in relation tocanBee-laced-on reverse side FOR DEPARTMENT USE;ONLY it APPLICATION ACCEPTED ------- --------- DATE.'____A� ------ ---- : REVIEWEDBY----'_---------------------------------------------------------- ------ DATE----------------------- ----------------------------------- BUILDING PERMIT ISSUED---------- --"----- ------------------------- DATE--------------------- ------- Alterations and/or''recommendations:------------------------------- ----- --- -- --------------h - i -------•--------------- --------I-------------------------•-------------------------------- ------------------------------ - -... ii -- - ----- ----------------- k i FINAL INSPE Date------------ / # SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California