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FOR OFFICE USE: -------------- ------------------- --------------- _ No.--------------- -- -----------------------------_---- APPLICATION FOR SANITATION PERMIT Permit ........._.._.... - . ---------------- ---- ----------------- + , i (Completein Duplicate) Date Issued q�� // This Permit Expires 1 Year From Date Issued .-.-.. .- -Z.70.� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549 1. S l _ JOB ADDREs ND 6 ATION_ ....-Ss-i-DE----- -- S p........W Q.r------L -•.--.1 V a a Owner's Name---------- ----------�-----L�--�-------•----�-1-��.�n� -- ------------------------------------ - Phone------------------------------------ Address T ... 1------------'- C LO ----------------------------------------- Contractor's Name--------©.WN_F-F-1--------------------------------------------------------------- ---------------------------------•-•----•--- Phone--------------•------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Fsvort Motel ❑ Other ❑ f 1 Number of living units: ../.-_ Number of.bedrooms -;Z Number of baths .L.-. Lot size ------- .. ----------- 2 _- rL_ Water Supply: Public system ❑ Community-sy tem ❑ Private Z/Depth to Water Table 1f ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe[:] Hardpan E]Previous Application Made: (If yes,date--------------------) No AFT"" New Construction: Yes El No HA/VA: Yes ❑ No._ TYPE OF INSTALLATION AND SPECIFICATIONS: "! ' (No septic tank or ces--spool,permitted-if public sewer is available within 200 feet.) - --� --• -- Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------M-aterial------------------------------------------------- E�CIIST'i INS No. of compartments--------------------------Size--------------------------------Liquid ddAepth---------- ---------Capacity----------------------- Disposal Field: Distance from nearest well...,-0_-_--Distance from foundation...-IY...._---.Distance to nearest lot line�.`-�............. X%T1"4 f�---r Width of trench? D� Number of lines_._....--- Length of each line Ar ------------- --- 9 p "1— Type of filter material---R-0Cr�i-----Depth of filter material-----�--f--_-._-..Total length.......................- ---------- Seepage Pit: Distance to nearest well--------------_..'~-..Distance from foundation--------------------Distance to nearest lot line.--_--.__._.._ ❑ Number of pits----------------------Lining material---------------------.Size: Diameter-----------------------Depth--------------------------------- r Cesspool: Distance from nearest weli-----------------Distance from foundation..----------.-------Lining material-..-.-_----.-..----------_-__-------- �f �-•-- - ❑ Size: Diameter------- i----- -------- r ----Dept-h-------------------------------------- -------------Liquid Capacity___--------------------gals. 1 •, i Privy: Distance from nearest uielL------ -------------------- -- -- --Distance from nearest building--__-_.-..-.----_----- --- CW --------------- p ❑ Distance to nearest lot line --------- ---------------------------- ------------------ Remodeling ----------------Remodeling and/or repairing (describe):----- - .--C C -------- + --- ---- C VV G. � TT R. G� ( _( ------------------------- ------------------------------------ -------------------------------------------- ' ------------------------------------------ - b l ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------ C------"------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and r and regulations of the San Joaquin Local Health District. (Signed} ------ --------- -------------------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------r=-----=------------------------- -- -------(Title)------------------- ---------- - ------------ - - ------------ -(Plot plan, showing size-of,.lot, location of system-in relation-f.o_wells, buildings,.efc.,.can be placed,on reverse side).!- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ---------------------------------------------------------------- DATE------- "J REVIEWEDBY-------------------------- ------- --------- ------------------------------------------------------------------------------- DATE-------------- --------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ------ -------------------- DATE------ Alterations and/or recommendations:..... .-.- . - ------_ it�xr ._ ��.._-...-.�--,,S�-Gam_------ ------------------------ -----•---- -- �?�---�---- ---------------------------------------------------- ----------------------------- ----------------------------------------------------------------------------- -------------- ------------------ ------------- ---•-------------- - -------------------- -------------------------- - ----- --------------------------------------------------------------- -------- - --------------------------------------- --------------------- r FINAL INSPECTION BY------------- - ------ ------------------------------------ Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.