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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. c2Z2,1.-fid ---- ------ --- ----- ----------- ---------------- -- (Complete in Duplicate) -- This Permit Expires 1 Year From Date Issued bate issued . _": P�..� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein c1scribed This application is made in co fiance with County Ordinance No. 549. AT� JOB ADDRESS AND LO TION --------------------------- A u r / SAG i � -- ------- ---------------- -- --- - - _p - - ----------------------------------- ------- ------- Phone-----------•-- ------------------•--Owner's Name---------- -- R - • / l- � 1 ��H — Address-------------------- ---' 13ox---------------- ------------ . --- ---:----------------------------------••--•--_---------- Contractor's Name-----PwNi!_Azl----------------------------------------------------------------------------------------------------------------- Phone.----------------- ------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer 4-rnart eMofel ❑ Other ❑ _ e &. Number of living units: -__ --3 Number' of bedrooms .-�--- Number of baths __/-_--rLot'size ------�----��'�S.'---��-5- ��n Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand eGravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: llt yes,date--------------------1 No O--�-New Construction: Yes Q--No ❑ FHA/VA: Yes ❑ No Er-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Sept �T k: Distance from nearest well__.S�----Distance from foundation----/.0----------Material--- -C- ©-Q- ---------- L� No. of compartments-..---..2------------ -- - _ .Liquid depth----.. jam~---Capacity_-_----60 9 Disposal Field: Distance from nearest well_.--J�----Distance from foundation---..LQ--------Distance to nearest lot I �.+-�._--.--. FeK Number of lines---------- _--------------------Length of each line_______�ry-- ---- Width of trench-__--_-2_-_ Type of filter material___ `AGK---Depth of filter material----._.�_-----.--.-Total length----------------------- LQ------.---- Seepage Pit: Distance to nearest well-.---- ------ --------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... -----------"Depth------------ -i--------------i--------Liquid Capacity---------------------------gals . Privy-. Distance from nearest well--------------------------------------.----------Distance from nearest building----------.----------------------..------. [] Distance to"nearest lot line------------------------------------------------ r---------------------------------------------------------------------------------------- Remodeling and/or repairing (descrl$e):---------- --------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- --- ------------------------------------------------- ------------------------------------ -------------------------------------------------------•--•- -t----------•------------------------------------------------------------------------------------------------------------------•------------- ------------------ --- ----------------------- --------------------------------L- ----------- ------ :---------------------- ------------------------------------------------------------------------------------ -------- - ----- - ---- -- 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 regulationsofthe San Joaquin Local Health District. (Signed)• ' - -------------------------------------------------------------------------- -(Owner and/or Contractor) By: - - z ----(Title)------------- ------ ------------------------------ -•----------R -----------------.------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ` .1k, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------T-2-R_-0----------------------------- ----------------------------------------- DATE------ ------------------ REVIEWED BY--------------------------!tn------------------------------------------------------ ---------I-------------------------------- DATE--------------------------------------------------- ------- BUILDING PERMIT ISSUED------V----------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:--fVaT-�.-_..Cf 19.tqG-•-_-------f -------- ---- 11. ?-------------- ---------------------------- --------------- tr4k r ------------------------------------ -------------------- ------------------------------------------------------------------- --------------------- ----------- -------------------------------------------------------------- FINAL INSPECT - ----- Date .... -- G.`r✓'. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazoiton Ave. 300 West Oak Street r y24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.