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FOR OFFICE USE: - r - ---------------- ----- ' - ------------------ ---------- -- - --------------------------- ------------- -- ------------ APPLICATION FOR SANITATION PERMIT Permit No. _ - -••------ in Duplicate) 4 -------------------------- ----------- (Complete p Date Issued 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'deesc�re_dd.. This application is made in compliance, with County Ordinance No. 549. , EA5'r� .-------A`i`--1.)Zvp' ,RD; JOB ADDRESS AND LOCATION'--_��-L7-�'v�__. ---. D�.._ i Owner's Name----------! ------ K�--� ------------- - Phone_ - -SUS ��r�' = ------- - QT--------------24#---------------------------- Address------------------- - - Contractor s Name-------FU_i-_L,7�_�------------------------ � ------ Phone----------------------------------- Installation --------- ••--------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_--I--- Number of bedrooms -3... Number'of baths _2-- Lot size -------/------- -------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -3r ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ElAdobe pan ❑ Previous Application Made: (If yes, ote---- --------------I No Z3-' New Construction: Yes RNo ❑ FHA/VA: Yes ❑ No d _ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t L Mal �G? �C1=T I Septic Tank: Distance from nearest well s.__. - --Distance from foundation__.J- ater No. of compartments.----- —----------SizeX1 -- -5 ---Liquid depth---y �----------Capacity---1`1- ---- 1 �Q z Disposal Field: Distance from nearest well._._-�----.Distance from foundation____.. ._ --------Distance to nearest lot line ------- � Number of lines-----------�_- ........----------Length of each line--___J,�o_�--i,----Width of trench..-.--; ------ -------- 4-7 Type of filter material__13 `�_ K......Depth of filter material----. -1__.---------Total length----------------41 ---------------- Seepage Pit: Distance to nearest}well----------------------Distance from foundation----.-------------- Distance to nearest lot fine_____________.__ r ❑ Number of pits------------------- Lining material-------- ------------- Size: Diameter-------- -------------Deptn--------------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------..-.---_.._---------_ k ❑ Size: Diameter------------------ ------------------Depth--------------------------------- - ---------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-_---------------------------------------------Distance from nearest building----------------.-.---------__-_-..___.._. I ❑ Distance to nearest lot line-------------- --------------------------- ---------------------------------- v « . Remodeling and/or repairing (describe):------ ------------------------ ----------------------------- -------- ----------------------------r----------- ---- --- ----- --------------- -------------- ----------- -------- - ---------- ------------------------------------ - --------------------------- ----- :: ------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- ------------------------------------ ------- I h eby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance Sate laws, and rules and regulations of the San Joaquin Local Health District. -------- --- -------- -_. -.-- � � �` `(Ow d/or Contractor)_,,,.y.. 5i ned ___ ner�an .. [ 9 _)..._ ----- / Lr� ----------------(Title).......... ------------- ------- --------- -- ---- --------- By---- ---- ---- ------- ------- -------------------------------- E (Plot plan, 'owing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----7F,-9-' ------ DATE----- -R..` - ----------- ------------------------------------------- REVIEWEDBY----------------------------------------- DATE------------------------------------------------------------ 1 BUILDING PERMIT ISSUED------- ------------------ ---------------- --------------------r---------- DATE------------------------------------ - ---------------------- Alterations and/or recommendations:----------------- - -- ---------------------' ---------------------------------------- -------------------- --------------------- -------------------------------------- _ -------------------------------- ------- ----------- ------------------------------------ --------------- -- ---•-------- �. FINAL INSPE LTION BY--- -Kt-w! ' ----------- Date----------------------`---- ------ --------------------- I FINAL INSPE TION BY:. _:C��s_Q-- -- ---- -------- ;. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CG.