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rvrcurri,_t uot: -------------- -------------------------------- ---------------- ---------------_..-____________________._-.-____.-----__-_. APPLICATION FOR SANITATION PERMIT Permit No. _ .................. -------------------- ------- ---------- ----------- (Complete in Duplicafe) 'G3 ----------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ---11:_:l____~ 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. �- .,j . JOB ADDRESS AND LOCATION.__,,31e_ ,__--kJq _ qG ;j — f , tZ Owner's Name___ Wd - 6 ----------•------- -- Phone-----•-------- - -- Address - ..... ��f'� � .� `ZED"Y(� Contractor's Name-___-. .-- STN---------- -------- Installation will serve: Residence J4 Apartment Houser[] Commercial [] Trailer Court ❑ Motel ❑ Other ❑ I � Number of living units: _1____ Number of bedrooms„?-_-_ Number of baths I---_ Lot size _J_76_'_Xb3_____._ i Wafer Supply: Public system ❑ Community system ❑ Private 54 Depth to Water Table a Q_ ft. Character of soil to a depth of 3 fee+: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Herdpan L] Previous Application Made: (if yes,date_________ __ _____) No R New Construction: Yes R1 No ❑ FMA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_N'3V_�____Distance•fro- .,foouundation-IV_______-__.M serial----'Fet/w .� No. of compartments-----2 ``'' ----------- Liquid depth__q/� -------------capacity_.. Disposal Field: Distance from nearest well__.�`.�._ _'Distance from foundation---Ad_______.Distance to nearest rat line----%T--/ Number of lines_____- -_-__: pLength of each line_____ 640-4r r --- ----- - - g ---�-�--- Width of trench_.e�_---_--fir --------------- Type of filter material____ C -----Depth of filter material____*_________-_Total length_____1 — ------____.-------- Seepage Pit: Distance to nearest well------------_tt-------Distance from foundation--------.-----------Distance to nearest lot line----------------- El Number of pits----------------- ----Lining material----------------------.Size: Diameter_---------------------Depth----------------------------- Cesspool: Distance from nearest well------------------Distance from-foundation._ _-_"�'__-....Lining material-_____________________________________ ❑ Size: Diameter---------------------- � I pth «* ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________ ------------------------.._Distance from nearest building ❑ Distance to nearest lot lire-------------_______ _-_�"-_"`—""�+ Remodeling and/or repairing (describe: — --- --------- I----------------------------------------------------:------------------------•---------------- ____________________________________________________ _ _________________________________ ---------------------------------------±-----------_-------------------------------------- ----------------------------------------- ----------_--------------------------------------------___________-_-_--__-_._-________ --------------------- -------------------------------------------------------------------------------------- ----------------------A-------------- ------------------- 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. ?_ - A. (Signed)--------------------------------- ------ ------ ----------------- ----------------------------------- ---------- ----------_------(Owner and/or Contractor) I __ -- BY---•-------��-- ---=---- -- - -- --- ------�-�---------------------------------- -------------------------- -----(Title)----------�------- ->--- - --- -- .-.-.. .- ---- ---- -� (Plot pian, showing size of lot, location o system in vela+ion to wells, buildings, etc., can be placed an reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ SZ,_ -------------------------------- DATE - ' --------------------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------ ---------------------- DATE-------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—--- ------------------------ --------- DATE-------------------=---- - -- Alterations and/or recommendations--- --- --------- -------- ------ ---------------- ------- ------------- ----------------------------- ------------------ ------------------------------------------------------------------------•------------------------------------------------•---------- --------------- ----------------------- ------ ----------- ----------- ------------------------------------- ------------ --------------------------- --------------------------------------------•--------------- FINAL INSPECTION BY:---- Cr - - - ---------- Date �—:- � 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 I r.P.cn.