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r FOR OFFICE USE: . -, - ! APPLICATION FOR SANITATION PERMIT Permit No. ...,........... .. ------------------------------------- 6(Complete in Duplicate) T17i s Pe�rliit-Ex ices 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 compliance with County Ordinance No. 549. JOB 'ADDRESS AND.LOCATION------16 --------- , z.a ------------------------------------------------------------I-------------------- ----------------•-------.----- Owner's Name--'VJZA,� ------ ------ R, ----------•------- ------•---------------------------------------`------.-. Phorie._4:�_a- 1 } t i -------- --------�--i,----=---- ............... Addre'ctar-- Na 1" —--------------------------•--.-----------------------•--------------- � 1 I A ress A: e Q _ _ -------- Phone----------------------------------- ----------------•--------•---------•-------------- Installation will serve: Residence [8 Apartment House:❑ Commercial Trailer Cwurt ❑ , Motel ❑ Other ❑ • I I , Number of living units: _,��_ Number of bedrooms _ - Number of baths .- ^.- Lot size ____ .Q_____?t-_3--5?.C?-------------------------- i ¢J i_ �. . Water Supply: Public system ❑ Community system ❑ Private ❑{ Depth to Water Table -------- ft. Character of soil 4o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe t& Hardpan ❑ Previous Application Made: (If yes,date-----1--9_1k_4-1 No E] New Construction: Yes No ❑ FHA/VA: Yes ❑ No El TYPE 'OF INSTALLATION AND SPECIFICATIONS: 4) (No septic„tank or ceSSP991LI5`ermitfed if public.sewer-is-available within 200 feet.) i ' Septic Tank: Distance from nearest well----_--_------_-Distance from foundation--------------------Material -.--_----------_------------------.------------ Li cid de th----------------- --------Capacity--------------------- No, of compartments--_: t - Size. q P. Disposal Field: Distance from nearest well_S ..Mvn,Distance from foundation.. Q.+t�,l :.idistance to nearest lot linei- iR4► ENumber_of:lines ------------------Length of each 1lne__ _,_uSa-3-- .Width of trench-----,- --4------------------ Type of filter material--- �;4s.k—------Depth of filter material------PS...t_....Total length-J...1,�_S_!------------------------ Seepage Pit:--` Distance to.nearesf;wel ---------- --- -.-.---_ Distance from foundation-------------------Distance to nearest lot line-------- �_}--- -- -- - t j ❑ Number of pits - Lining material---- ------- ---_ Size Diain'eter `------------- Depth-.---.---------....---------_-_-- Cesspool:� Distance from nearest—w`ell_____ -:Drstance from'foundafion ”- Lining material ---":"-"-*------------_---.--. ❑' :. Size: Diameter---------------I---=--'-------- ' `- Depthz_` -?--. ----- -- Liquid Capacity----------------•-----• gals, i Distance from nearest building.-' .---. Privy: Distance from nearest well-----------------`-------------------- g- ' �r , w Distanceto nearest slot line- -�-'' -------------------------------------------•'-------•------------- ----------------------k--•------------•------------ •-------- k i f ---------------- -----=-----------------------------------------------•-•-------- ------- Remodeling and/or repairing (describe)---- ---------------- - - -------- ' �..-- 4 r i i i _________________________________________ f- --ti_ t A '-----"-"-R-'-- ---------------------------•_ .." --.-_-..----__..----....-----••-...-----_-.-------------------------..._ I I.hereby certi that I have prt'epared this-application and that the work will be done in accordance with San Joaquin County ordinances, St . aws, and ru�es�an�gulons of the,San Joaquin Local Health District. (lel .r f r E _ (Signed} �''�' ------ ------------------------------------------------------------------ ----- -(Owner and/or Contractar� lBY- -----------------------------------------(Title)------------------------ ------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). + + F FOR DEPARTMENT USE ONLY r � APPLICATION ACCEPTED BY--------------' - DATEj' �S {c ---------------------------- REVIEWED BY------------------------------- I �----"`---'""'-- DATE. -- -------- BUILDINGPERMIT ISSUED------------------------------------------------------- ---s---------------• ••-----..---------.... DATE.-..---------- ` Alterations and/or recommendationsz_.'_-:-_------._----.----__ .-_---- --•----------------.r ...--------•---•--------•-•---....------•---•-••----------•------------• ' t _ __ i -------------- -------------- ------- ------- --•-----------•.----------•--I •--------------•----- -- -------------------•--_----•--'----------------•---------••--------••-------••------ -------------- ----------------------- - ---- ------- ------- ----------------- -------- ---- ---------- ---------�--- -- -• •.......--•--------- -----------...------•--- i 4 1 FINAL"�IN�SPECTION'-BY:`� ------------------------------ ----`�--=-- -'--- -.. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 sycamore Street 245 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CII REVISED II R.P.CC,ZM 6.80 L- - I'