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FOR OFFICE USE: ~ - r -------------------------------------------------_--_--- j APPLICATION FOR SANITATION PERMIT Permit No. sz__ - ------------------ !� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 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. ZC 4 -k� !f JOB ADDRESS AND LOCATION------7--�-------------�-��------------At------------��F��------------------LATH Owner's Name--------- } 1_LnLj --•------�fJ _�—TRwu .� _Q. --------6Q.---t Phone. Address ----------,3� -------------------Z-4MOQ r� ��rr ------------------•----•------------•-----------------------------..-_-----•---- Contractor's Name----------ry rvu=� --------------------------------------------------------- Phone--_..---------------------------- Installation will serve: Residence ff�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑L Other ❑ Number of`living units:.,_____ Number of bedrooms , ___ Number of baths -1--i Lot size ----- 14090 yb t Water Supply: Public system Z_Gommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ®'ravel ❑ Sandy Loam ❑ i lay Loam E] Clay ❑ Adobe E] Hardpan Previous Application Made: llfyes,date....................) No New Construction: Yeses o ❑ FHA/VA: Yes [J�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ( septic p p p lic s wer is available within 200 feet.) ' f t Distance from foundation____ __ __ _________Material__S. 9 _� Septic T nkse tic ta�stancesfrom neo east well--�-;�_ � IV_ ,R�� --_.__. �kx iN"O". of compartments_`__ ____._____Si±e__ _ rD_k__ Liquid depth____l� .-�- .-..Capacity_;--/ Q_0_� Disposal field: Distance from nearest w !I_, a__ _ .f �._Distance from foundapt�ion.��sJ__.__.._Distance to nearest lot line___��__. ....-�___.__ ---_-Length of each line__ r6i ,S_4.5Width of trench-"-- - -��- Number of lines_-________7-1-. .__....__{.._ Type of filter material -; : Depth of filter material-_ ..._--_Total length___________________/_90________ ' ' Seepage Pit: Distance to nearest wel!_>-------_------------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-------- ---------------------_-_-_- Z ❑ 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):------------------------ -------:---------•---------••-------•----w--- ------------------------------------- --•-------------•------------------- --------------------------------------•-- ----------------------------------------- ------------ - -------- ---------------------------------------------------- 4 -----------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i I hereby c ify that I he prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and es and r ations of the San Joaquin Local Health District. II {Signed — "------ -- - - -�---�-------------- ------- - - ----- ---------- ---- - -------------------------------------(Owner and/or Contractor) By: t t + { ) B :-------------------- �'�`[ Title ----------------- ---- -- -- ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc.,�can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-- .F t Ll_- --- - --- ----------------- ---------------------------------------- DATE--- r� ` REVIEWEDBY-------------------------- -------------- - - --- --------= -- -- ---- . I -- -- ------ -- --- --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------- -------------------------------------------- DATE-------------------------------------------- ------------------ Alterations and/or recommendations:---------------------------- ----------------------------------------------------------------------------------------------------------------- ----------------- r ---------- ----------------------------------------------------------------------------- ---------------------- ----------------------------------------------------- ------.... - -------------------------------------------------------------------------------------------------------------------- R FINAL INSPECT�@W -8�-�- �/.- Date---------J__r Z�j r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California r.P.CC.