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FOR OFFICE USE: ---------- -/, �, ' APPLICATION FOR SANITATION PERMIT Permit No. .�. ___ .. __3 "------__"_-- )Complete in Duplicate) f Date Issued ---4- ----------------- --,---�� - `This Permit Expires 1 Year From Date Issued Application is hereby made to the Sen 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. tP JOB ADDRESS AND LOCATION `� 9�d - - ------------------ - -------------------- -------------------------------------------------------------------- A Owner's Name /5�0'7 -1_. !/Y __.. _- Phone- ---------------------••------ ---- • ------------------- -------- Address s 5_.3s .._ i — ------ ---------- I CJ- ' -!_ _.---------- Phone...-------------------------------- -Name------- __ "f''� 0-�,-f"__•------�:-----• - -- ---- -- ----- -- - Installation wiz serve: Residence part nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 Number of living units: 11- Number of bedrooms �_____ Number of baths .__t!_ Lot-size ---�� ._._ _1..7-. ---------------------- Water Supply,. Public system ["Community system ❑ Private ❑ Depth to Water Table '16- ft. Character of soil to a depth of 3 fee Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loaf ❑ Clay ❑ Adobe [?r Hardpan ❑ Previous Application Made: (If.yes,date............._.._-_1 No -,New Construction: Yes VNo ❑ FHA/VA: Yess ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t" f Septic Tank: Distance from nearest well------ _-___--Distance from foundation-_'4-1 '----.___._.Material_........C_________________e� �! No. of compartments_. . ' --Size-- 3'x-`-�-X-'7------------Liquid depth.--f------------- apaufiy... Disposal Fields Distance from nearest well______ _____ Distance from foundationl ----------------Distance to nearest lot line_►.2_.----_---- . Number of lines ------ -----------------Length of each line--70_..-----_-_-.-,_ ---Width of trench.__.'�._3_ - ___.__..--------- Type of filter -._-.--_Depth of filter material__1I?�..............Total length---- I ength_.-_ - Seepage Pit: Distance to: nearest well__� f-----Distance om f undation__lQ____,_____.D�stance to nearest lot line-_.______..___._ ❑/ Nu ber afIpits_-----.�.-.------Lining material-_- . . _-.___size: Diameter--Z-3-----------Depth.......;Z-,�__...__... .____-__ Cesspool: DistanceIfl'Oml nearest well-----------------Distance from foundation------------.k_____.Lining material.__.___- ❑ Size: Diam=eter-- --------------------- --Depth--------- -------:------------'-- Liquid Capacity ' gals. ' l 4. __.-Distance from Inearest buildin Priv Distance from nearest well ----------------------------------- -- - g--------- ----------------- --------- - ------- ,.,... �._ ❑ .....�:�...V..,.F- to nearest lot lin—e .--,------------------------ -------•---------------------------------------------- r -- ------------------------ Distance . ----------------- Remodeling and/or epairing (describe--------- - ------------ - 1 .� `_ __ _________._________________--------_----_-_ _______---..-----------------...------------------------------__. ----------: ' -- - ---- � ------�*- = ------------------------- 144 'h -------------------------------------------------------------------------------------------------- --- , r.. 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 ------ - ----.(Owner and/or Contractor) (Signed)--- ------ ------- - --------- ------ r ---------------------------------------------(Title)---------- ------------------ -- ----------------- --- --------- --=(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r s 1 I FOR DEPARTMENT USE ONLY t / APPLICATION ACCEPTED BY ------------------- DATE---l.--�I2--'"------------------- REVIEWEDBY.------------------------------------------ -------------------------------------------------------------------------------- DATE------- --------------------------------•------------------ BUILDINGPERMIT ISSUED------------- ------------------------ •� ---- --•----------' DATE.------------------ -------------------------------------- Alterations and/or recommendations: - L '-J``�-----Q`C ' ==� 1 --- II --------------------------------------------------------------------- i -------------------'---•r Z 1 ------ ' ---------------------------- ------------------------t-=------------I i -------- Date--.------ ---------------------'------------- FINAL INSPECTION BY: `�c� - r r i SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street a —124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California w Manteca,California Tracy,California