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FOR OFFICE USE: ----•------------------------------------- -------------- :.. ."' APPLICATION FOR 'SANITATION PERMIT Permit No. A2-23Z2�:2- ------------------ ------------------ --- '. (Complete in Duplicate) Date Issued Z/:f:rR/„_SZ' 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 tomliance with County Ordinance No. 549. - f�ro JOB.ADDRESS AND LOC TION---- -I__Po : I. .... F h I ` 5 = Owner's Name------------------- L(3 .1 - -----------�� L-� .1` I.lZ --- -------------------- Phone----•-------------------------Address-------------------•-• • ----- Z 4 �f .. - D ---------------------------------- Contractors Name-----------OW-A-F-K----------------------------------------------------------------------------------------------------------- Phone----••-"------------- Installation will serve- Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __ -- Number of bedrooms _3--- Number of baths _1____ Lot size _-ACK &P--i7------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ��Lft. Character of soil to a depth of 3 feet: Sand 2 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan,❑ Previous Application Made: (If yes,date--------------------) No 91/New Construction: Yes ❑ No FHA/VA: Yes ❑ No. TYPE OF INSTALLATION AND SPECIFICATIONS: -F = (.No-septic-tank'or•-cesspo6l permitted-if-public-sewer is'available within 200-feef:) Septic Tank: Distance from nearest well-----------._._-_Distance from foundation___________________.Material_-____.________.__..__.__...___--------.___i____. IXE ;V r4C— No. of compartments--------------------------Size---------- -----------------Liquid depth-------------------------.Capacity---------- = y + Disposal Field: Distance from nearest well__, a_..__Distance from foundation____41.Q---------Distance to nearest lot line___ r Number of lines_____--_---_ 4 �---------------------Length of each line-------�p_-_ -;�____--.Width of trench....__.a��}_______s--_-_�_-•.-, t � R DD Type of filter material---RO- Y1___.__Depth of filter material__-._-1.9__._ _._Total length------------------Zd---_-__--- 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'wO------------------------------------------------Distance from nearest building--------------------- ____.___...___�).... ❑ Distance to nearest lot line--------------- ------------------- --------- ------------------------- ---------------------------------------------------------------� ° r Remodeling and/or repairing (describe):---------il3fG_PJg- -------E-K_I.S-T1_N&----Sy°S--T-EEM-1' ---------- --•----------------- ----------------------------------------------------------------------------------------------------------------- --------------•---------------------------_-----------------------•------------------ ------------------•----------"-------------------------------•------ -----•---- ------ ------------------------------ 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. ----------------------------------(5igned / Oh (Owner and/or Contractor) � L- J � i Title) -- ---- ------ - ---- � - (Plot plan. showing size of lot, location of system in relation to/ells, buildings, etc., can be placed on reverse side). FOR DEi TMENT USE ONLY APPLICATION ACCEPTED BY---------- f�=-----------•------ 11 �.7- �Q- - 3 ------------------------------------------------ DATE-- ------ ---`----- REVIEWED .BY----------- -------------------------------------------------------------------------------------------- DATE----------------------------------------- ;I I BUILDING PERMIT ISSUED------------------------•--------- ------ DATE.----- Alterations and/or recommendafions:------- ------------------- --------------- -------------------------------------------------• ------••-------------••- -------------------------- ---------------------------•-------------------------------------------------------- --------------------------------------------------------------------------------------------- -----•----------------------- i --------------------------------- --- = --- ------ -- ---- --- - -- - ------------------------------------------ ------ - - ----- ---------- ---- -- ---------- ------ -- ---- --------------- --- - } -- --- ------ -- --- --------------,-------------------------------------------- ---------------------- -------------------- FINAL -- ------ -- FINAL INSPECTION BY:.- J Date--------------- -------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT - ) 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street ' t Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. $ t i�