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4 FOR OFFICE USE: ------------------------- - -------------------------------------- -------------- - APPLICATION FOR SANITATION PERMIT Permit Nfl. .��. --------------•-------------------------------------- --- (Complete in Duplicate) --------------------- This Permit Expires 1 Year From Date Issued 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 th County Ordinance No. 549. / C JOB ADDRESS AND LOCATION -----2L5SSO-------�--------rvIAHO� LScpL.Q .: Owner's Name------------ _R -.--------- ' I - Phone --------------- Address------------------------- 2S 5a 11 R NC?( ------------------ s _RJ I ------------- Contractor's Name------ _l '-E °- --------------------------------------------. Phone----------------........ --------- Installation will serve: Residence 92-"Apartment House ❑ Commercial ❑ Traile Court F] Motel Other Number of living units: _I----- Number of bedrooms 3---- Number of baths 22 Lot size __`Q___/ •S-__ _---- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table3 _ f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ElAdobe ElHardpan Previous Application Made: (if yes,date..............------) No ,,New Construction: Yes No ❑ FHA/VA: Yes R-' ElNo Vill TYPE OF INSTALLATION AND 5PECIFICATIONS:� r� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: Distance from nearest well------5O Distant from foundation__.__.____ ._.Material__-- Qll)Cr [g— No. of compartments---------- ------Size_______I-0- __5----Liquid depth____ . -----Capacity__, OQ- 10 ___.Distance to nearest lot line------ _.. Disposal Field: Distance from nearest well.----- _ d._Distance from foundation___.___- __ -- Number of lines-----------____....___ Length of each line---------!�O...............Width of french-------- 'r Type of filter material.___R0_C— __Depth of filter material-.-.-/- ___ _-__Total length-__ �QQ_ _r--- Seepa Pit: Distance to nearest well______ /��._ _Distance from foundation-____ {- - - 1(.------- DistanceJ to nearest lot line____•_ Number of pits--------7—.....Lining material_ Q_C ___..Size: 13iametereY_73_-__Depth------_--- ,2.................. 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, and rules and regulations of the San Joaquin Local Health District. (Signed)= = - --_--••:- (Owner. and/or Contractor)_ - --_-- or --*1.64 By:---------� -----------(Title)----------------------- ----------- ot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY----` [' ------ - ----------------- ---------------------------------------- DATE-------- REVIEWED BY--------------------------------------------- -------------------------------------------------- ---------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------------- -------------------------- ----- DATE------ Alterationsand/or recommendations:------ ------ ---------------------- ------- ------- ---------------------- -------------------------------------------------------------------------- ------------- ------------------ FINAL INSPECTION 'BY _ _-- --- Date_- _ �/=----- - c SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 9.Hawaiian Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ! F.P.0 C.