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FUK `JrriCt Ust: --------- ------- -- -- 4---3._vtM ki F-f"---------- APPLICATION FOR SANITATION PERMIT Permit No. .g.e)zZ ------------------------------- --------- -- (Complete in Duplicate) Date Issued Z:77�.��2 - --.------_--------------------------------------------- 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 herein described. This application is made in compliance with County Or inance No. 549. JOB ADDRESS AND LOC - ---------------------- ATIO -- }� T --•--------------------------------- ------------------------------------------------ Owner's Name---- R ---------------- Phone----••----------- Address Pq •'OK_42---------- - f Contractor's Name---------- ---- - -----F' t J------- -- - -- Phone----.,------------ ---------------- Installation will serve: Residence B__<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i '1 Number of living units: --`-- Number of bedrooms _- Number of baths - --- Lot size ... ------------------------- Water Supply: Public system ❑ Community system ❑ Private E?Tepth to Water Table<3 t- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe 2"Aardpan ❑ Previous Application Made: (If yes,dote------------------ -I No 2}—New Construction: Yes k}' No ❑ 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: Distance from nearest well--t0_V.`__Distance from founclation-—0-- _ ,_ -- --.Material-- -e_,�� ,t� w r No. of compartments--,?.-_-_-V------.Size- - --*Liquid dep.h...... ._____ Capatity� +✓+ _-_. Disposal Field: Distance from nearest�weli.4-29--.-._Distance from foundation--649 .Distance to nearest lot line-Z49-- ®� Number of lines--------- Length of each line--gAO------_-_ Width of trench-2------------------------------ ,Pl-.--Depth of filter material--- __________Total length --------------------- Type of filter material-/ l/ !' Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size; Diamefer-----------------------Depth_------------------------------- V1 Cesspool: Distance from nearest well-------------- Distance from foundation---._-------- -- --.Lining material___-__--.-.----.----.-.------- ----- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ----------_------ -----------------------------Distance from nearesf building----------__-__--------------.-.---------. ❑ Distance to nearest lot line ------------------------ ------------------------------------------------------------------------ - Remodeling and/or repairing (describe):-------- ------- `'�!°v �Gr'FaZr ------------------------------------------------ P -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------ --------------------- --- ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 rgulations of the San Joaquin Local Health District. (Signed)-------- ------------------------i----- '--------------- .e,. ; - ------ -- -------- --- --------------------------------------.-(Owner and/or Contractorl By:------------------------------------------------------------------------------- - ---- '----------(Title)---- - (Plot plan, showing size of lot, location of system in rel ' n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- o --------------------------------------------------------- DATE-----,- a!__4115----- ----------------------- REVIEWED BY---------------------------- - - -- -- -- - -- ----- ----------- ------------------ ------ - ------ - �- ---- DATE PERMITISSUED----------------------------------- ---------------------------------------------------- ------- DATE ------------------- Alterations and/or recommendations:-------11,>@_ £d f - -------- h-- Q----"------ - f_ -f--- --Ate' -----.--/:7-. rrvG_o � - ------------------- ------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- -------------- --- ------ ------ - --------- ----------------------- ------------- ---------------------------------------------------- ------•----------------------------------------------------------------------- ----- ---- --- ---------------- FINAL INSPECTION BY:---sr-_-_ =-lu ---------------------- Date---- -- --- -7 -� 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 F.P.CC.