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FOR OFFICE USE: -------------- --- -------- ------------- ��j---- APPLICATION 1=011 SANITATION PERMIT Permit ---------- -- -- ---------------------------------------- (Complete in Duplicate) �S k Date Issued --- --•-•� - ---------------------------_. 1 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 Ordinance No. 549. JOB ADDRESS AND LOCATION---------------- ---- �---------t-,._:...... I.(N(-------------------------------------------------------_------------------... Owner's Name � ` = G --" l C�" ---------------- '--------------------- Phone--�CJ27--KRK - ---------~ / Address-------------------------------------------------+-.....�� L +�--•----�-A1-0---------------------------------------...-----------.. ......-------------------------..._.. Contractor's Name---------------------------------�A i.... �`� {�= �� C----------------------------------------------- Phone---41 1 ��_C��_ , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑. Other ❑ Number of living units: __t___ Number of bedrooms Number of baths __I____ Lot size ____/ hQ�_______________________ a Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam Clay E] Adobe[-] Hardpan C1 I Previous Application Made: Ilfyes,date--- .........-__--1 No New Construction: Yes ❑ No t;d , FHA/VA: Yes ❑ No� t 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--------------------Material----------_------- - -----. ❑ No. of compartments------------ --------1---Size--------------------------------Liquid depsh-------------------------Capacity-----------------�--- Disposal Field: Distance from nearest well---(0`�-_-_-_Disfance from foundation--_-�S___-.--Distance to nearest lot line-/-- Number of lines-------------------j---,-------- Length of each line----_------ d-r--- ---- Width of trench-_____--;- `1----------------- IIS Type of filter materiaL__Z----J_er ._Depth of filter material.-_-__1_. '_`--_ Total length----------(00_`----------------------- Seepage Pit: Distance to nearest well----- fr m foundation___. __.___.Distance to nearest lot line_- ____-__ot rJ f -----,Lining material- � -------Deptn-..-_---.Z_�-----f---------- Number of pits___--_.____-___- -Size: Diameter.____-____ ' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.--______-___- rn ❑ Size: Diameter---------------------------- -- ------Depth--------------------- ------ ----------- ----------Liquid Capacity----------------------------gals. .. Privy: Distance from nearest-well.---- - --------------------------------------- .Distance from nearest building-_--_---______-_---__-__.------.-___--. r'f ❑ Distance to nearest lot line--------- --------------------------------------------------- ------------------------------------------------------------------------------ ` Remodeling and/or repairing (describe)-------------P__�-A --(A-1_b-N-----------�--------- `�--•------- F (? -------------------------------------------------------}------------------------------------------------------------------------------------------------------ ------------------------------------------------------- 3 . I ----------------- ---------------------------------------------------------------------------------------I--------------------- --------------------------------------------------------------------------------------- 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. - -�.1-.. �5- ----------------- -------------------- Owner and or Contractor I (Signed)---------------------------------------------- / ) By:---------------------------------=----•---•_--- ------ (Title) - ------------ ----. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y______---------- -- -- ______ _ __ _�' --`---'--------------------------- DATE '� REVIEWED $Y------------------------------- - - - --- ---------------- -------------- --------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIVISSUED----------- ------------------------------•----------------------------------------- ---------------- DATE--------------------------1-------------------------------- Alterations -------------------------------- Alterations and/or recommendations:-_-____ -__. «- ------- % --------------------------- ------------ -- �I-% '= �r- - - - 'a"- = ----------------------------------- -- --------------- --- ----- ------ ------------------ ------ -------------------------------- i ' ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.............------------------------------- � i� �+ -------------------- ate--------�---------------- - ------- FINAL INSPECTION BY:...--.------,_.-C-`.�. - D ---------------------------------------- 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 r.P.M3. 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