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FOR OFFICE USE: -------------------=------------------------------------- _---. APPLICATION FOR SANITATION PERMIT Permit No. -------- ----------------------------------- ------------- (Complete In E36plicatel _ . This Permit Expires 1 Year From Date Issued Date issued 24C7 —2-5; 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 complian a with County Ordinance No. 549. JOB ADDRESS`AND L- ATI - C�-'-- L " Owner's Name--------------- ® T o. -------_4!-P P-E_P--------••WA-1, ----------- Phone----------------------------------- RTZ Address = 'Z' - ---1 ok------------ 37------------------- - -r? , j @ ry --- --------------------------------------- Contractor's Name------VW j�(1------------••---•---------------------------•------------------------------------------------------------------- Phone.------------ ------ _----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms ....Number of baths I-- Lot size _-.ACR_ 6�----------------------' Water Supply: Public system ❑ C4mmunit system El Private [[Depth to Water Table �, ft. . 'ISiERy CAV Sli< O Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ❑ Hardpan Previous Application Made: (If yes,date---------------- ...-] No ET,-New Construction: Yes 2--'No ❑ FHA/VA: Yes ❑ No �- - - TYPE OF INSTALLATION AND SPECIFICATIONS:' ` —(No septic tank.or"cosspool permitted if public'sevyer is available within 200-feet.)--- b - --- Septi T k: Distance from nearest well---S pistanf_rom foundation---/ -_---.--.Material_ C 0VCR�7-E No. of compartments..___ ------.--_-Size-- Liquid depth_----- /2� CapautY 20®- Dis oral Field: Distance from nearest well---__A-�_.a-..._.Distance from foundation-- --------------- S p 1 Q Distance to nearest lot line(- _.-------- Number of lines---------------- g fQ --.i`----:Width oftrench.------..��-------/-----•-- -----------------Length of each lines----_- 9 Type of filter material----.RV_a _Depth of filter material-----1-- ------------Total length----------------Aw------------- 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-------------------- material-------------------_---__-------..-- r ❑ Size: Diameter- - -------------------------------- -Depth -----------:---------------- - ----------------- Liquid Capacity-.--------------------------gals., Privy: Distance from nearest well -----------------_"--------------------_------Distance from nearest building ❑ Distance to nearest lot line- - - ------------------------ ---------------------------------------------------- Remodeling and/or repairing (describe)-------------- ------------------- -------------------------------------------------------------- -•----------- -------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. { (Signed)-------------------------------------------------- ---------- -------------------- - -------------------------------------- -------------------------- ------.(Owner and/or Contractor) c -` - J._1 �1 .�rts�- :. 's' =_ --== == {Ti+le)-------------- ...-------------- By:_ _.--- (Plot plan, showing size of lot location of system in relation to wells, buildings,-etc., can be placed on reverse side. ~ FOR DEPARTMENT US NLY , APPLICATION ACCEPTED BY........ .r_�,--Q,-------- -------------------- -00--- ------------------------------- DATE------- DF ` REVIEWEDBY------- ------------------------------------------------------------------•------------------- ------------------------------ DATE BUILDING PERMIT ISSUED------------------------ -------------------------------------------------- ------------------------------ DATE-------------------------------------------------------- -- Alterations and/or recommendations:---------------*------------------------------------------------ ----------------I--------------------------•---------- ------------------------------------- ------ -----------------------------------•------- - . -- -------- ------------------------------------------- --------------------- ------------------------------- .............0 A ---------------------------------- ---------------------------------------------- -------------------------- ---------- ----------------------- FINAL INSPECTI -- ESAN - ^ JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.