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FOR OFFICE USE: --------------------------------------------------------- -____--------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _A-14 Q._... -------------- --- ---------- --- -------------- ------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _-_ f___�7 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-----6I_-��.._-------/V------- R-E.� —------------------------------------ 19-T-H--_.-_01---.-.------------ Owner's Name------ --4-11AI``P, l$-- ,,`r----•� ---------------------------------------------------------- Phone------------------------------------ Address-----------------�� --------[7�_4nm4R---------Lkt.--------------�_- t4All-Q7----------------------------------------------------------- ------------ Contractor's ------------- --------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 14 ` Number of living units: __- Number of bedrooms ____ Number of baths _______ Lot size __-__-_�--_--�--Z.-.�--_-"" Water Supply: Public system [��ommunity system ❑ Private ❑ Depth to Water Table 13 ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No.W___N_ew Construction: Yes Vo ❑ FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.s%wer is available within 200 feet.) 1 Septic k: Distance from nearest well__4;_ Distance from ` rtfoundation---10________Mate ial "C -e-T ________._ __Lqid depth__kep4 ____No. of compartments..-__ Mate Disposal Field: Distance from nearest well_cW_.Distance from foundation-----!V-------Distance to nearest lot li e__-_�>______... Fe / Number of lines-------.-7�----_.__-----.-.._Length of each line-1 ' '_f -.Width of trench------ /?_0 Type of filter material__K0_C�___Depth of filter material---f?..............Total length___________________/?_0---------- 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---------------- ---Lining material------------------------------------- El 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)--------------------------- ------------------------------------------------------------------------------------------------------------------------------ --------------•---------------------------------------------------------------------------------------------- --------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------__------- ----- ------------------------------------- ---------------------•--------------------------------------------------------------------------------------------------------------------------------------------- 1 herb rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws d regulations of the San Joaquin Local Health District. {Signed----- - ------ / --'� --------------------------------------------------- -------------------------------- --------(Owner and/or Contractor) �.. By:---------------------------------------------------------------------------------------------------------�'i-R.-P--------(Title)------------------------------------------... .. - - - (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_- - - - ---r REVIEWED BY--------------------------------------------- -------------------- --- ----- ---------------------------------------- . DATE--------------------------------•--------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------- ---------------------------------------------- DATE--------------------------- -------- - --------------------- Alterations and/or recommendations:------------- ------------------------------ -r----------•------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------- - ------------------------------- --------------------- ------ --------- ------------------------------------------ FINAL INSPECT .--- ------------ - ------------ Date------.... � � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 west Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0❑.