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F R OFFICE USE: . ----------�`- ----------- -� --- ---- ._ ..--_--..--_--------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ -------------------- ----- --------- (Complete in Duplicate) � Date Issued ---------------------------------------------------------- I ,This Permit Expires 1 Year From Date Issued- Application ssued 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. t JOB ADDRESS AND LOCATION------73- La_-57 �� Owner's Name------0-...�-------�-A&AAA-j.t-�AC_A&AAA-j_,-�--------------------------------------- -------------------------------------- Phone---�_-Z------ Address------- .--------C�`� _ a-VA- Name.----C ._(A.l -------------------------------------------------------------------------------------------------------------------- Phone..........-----------.............. Installation will serve: Residence [& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A---- Number of bedrooms _3--- Number of baths __ - Lot size ____�_O�_K___, z.7..Q�....................... Water Supply: Public system ❑ Community system ❑ Private ®, Depth to Water Table _w, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M, Hardpan ❑ Previous Application Made: (If yes,date--------------------) No T, New Construction: Yes No ❑ FHA/VA: Yes ❑ No 54 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----- �.__Distance from foundation------I-C?_1------Material_._/ No. of compartments----------Z-------------Size- `X_ �-ZS-S_� --Liquid depth----------4------------Capacity... ?_Od_ � Disposal Field: Distance from nearest well--4.-,C> Distance Distance from foundation----ick-1.........Distance to nearest lot line-------;........ �91 Number of lines___---;_7----------------------Length of each line------1.1.0.. Width of trench------.z-9 'I-__-__---__--- Type of filter material...h4-e.�-------Depth of filter material------L.5"___......Total length-----. ------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation.................--.Distance to nearest lot line--............__. � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.---.----------------- Depth_---------------.----------_---- Cesspool: Distance from nearest well.---- ------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter.---- ------Depth------------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------_------------. ❑ Distance to nearest lot line-- --------------------------------------------------------------•--•---•-------------------- _- Remodelingand/or repairing (describe):------- ---------------------------------------------------•------------------------•-•-------------- ----------------------•---------------------------- ------------------------- ----•----- ------•-- -. ------------------------------------------------------------------------------------------------------------------------------------------------------ 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, an rules and regul tions of th San Joaquin Local Health District. (Signed)----Ozct�- -------- / -'? --------~----------•---•------------------------------------------------------------(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------- ...... ••-----------------------(Title)------------------------------- ------- -------------- (Plot plan, showing size of lot, location of system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------L`.- ----- ---------- DATE-----'t-----17----b- ---------- ----------------- REVIEWEDBY------------------------------------------------------------------- ---------------- ------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------- ------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------•--•----------------•--•-----•-•------------••-•---------------------.....----.. ---•-•--------------------------------------- ---------•---------------• - -------------------------------------------------------------------------------------------•---------------------- -------------------------------- FINAL INSPECTION BY:---- +- --------------------------------- Date_..._4- ' S_��i7 .------------------------------------------- SAN JOAQUO LOCAL.HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycomore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California eEa-R9