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WFOR OFF CE UGE: APPLICATION FOR SANITATION PERMIT Permit No. . 1 A, -..----w. ..� . F .;r [Complete in Duplicate] ate Issued _r --r-, " •� .- z1fl �-.� n -So � _, Q _ fir.. / -- q Year From Date Issued q� �� Ju( r� �-'� ,This Permit Expires 1 Application is hereby made to the San Joaquin Local Health pistFict for a permit to construct and install the work herein descried. This application is made in .comp' nce with County Ord--mance-No. 549. 4 MTr t JOB ADDRESS AND LOC I _- _ - _�_ ------ Phone--------------- ----•--- --- W s----A-�-R- --T --mss Owner's Name. 1- QZ ------------ - s- P p2.z' ------- ---------------------------------------------- Contractor's Name------------2-W.0 -------•----- --- Phone--------•------------•------------ h.stallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Gau t gr-Motel ❑ Other ❑ Number of living units: ---1___ Number of bedrooms Number of at _ __..__ Lot size ---- ------------------------------ Water Supply; Public system ❑ Community system ❑ Private - Depth to Water Table _9-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------__--------) Nok�t�New Construction: Yes ❑ No DTA/VA: Yes 2�' No ❑ _ TYPE OF INSTALLATION AND-SPECIFICATIONS:_- T '(_Na septic tank or cesspoolpe mmiffed if public sewer is available within 200 feet. Septic T k: Distance from nearest well___ :__Disfan e from foundation----/p----_._..Material__ � �.fy-./ ---- No. of compartments-- ---��---------Size- --X-+�_�--�5--- ---Liquid depth---�--' -------CapacitY_./ Disposal Field: Distance from nearest well-_.J0-..-Distance from foundation____10---------Distance to nearest lot line___ ___� -1 ` Len th of each line?_i- ------Width of trench______�, .�- ------Y----- ' Cx Number of lines--A----------------------- g Type of filter material_R C -----.Depth of filter material---- ...--- ------Total length______________ ------ I +� 4 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- � h ❑ Number of pits----------- ----------Lining material-----------------------Size: Diameter-----------------------Depth---------------- Cesspool: Distance from nearest well______.._-------Distance from foundation__---_____.___.---.Lining material --- als. ❑ Liquid CapacitY---------------------- Size: Diameter--------------------------------------Depth------�------�- --- ------ ---�-------- ----- . 9 Privy: Distance from nearest well-------_._____- ______----------------------Distance from nearest building -------------.--------------------------- I ❑ Distance to nearest lot line ----------------------------------------------------------------- -------------------------------------------- Remodeling and/or repairing (describe):---------------------- ----------------------------------------------------------------------- \ -----------------------•------------------------------------ ------------------------- ---------------------- ----- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f ----------------(Owner and/or Contractor) (Signed) ------------------------ -- ---- -- ------ ---- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----Ti---R p--O-`--- ----------- --------- ----------------------------------------- DATE---- d ------------- j REVIEWED BY---------------------------------- --------------- --------------------------- -------------------------- -------- --- -------------- ------- --------- DATE------------------------------------------ ----------------- ) BUILDING PERMIT ISSUED---------------- ------------ ------------------------•------------- ------------ -------- -----__ DATE--------------•------------------------- ------------------ Alterations and/or recommendations.9_-.1_'-4o.7-----T1�N.K-----JAI- _'rA�4`6-A-------da<_---•---------nm.-0-•----------------------i----- •---•------------------------------------------- -- ------------------------------------- ----------------------- --- - --------------- ------ FINAL iNSPECTlO - --.-- - ,ti SAN JOAQUI ate---------- -------- --------------------------- N LOCAL H�".�. H DISTRICT , ,. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California fr