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rvx kit-NU: ubt: S. -------------- ---------- - --------- ---------------_-.---------- ------ - _.-----_--.- APPLICATION FOR SANITATION PERMIT Permit No. /- --- ---------------------------- - -- Com le+e•in Duplicate) (2ll --------------- --- ---------------------------- --- This Permit Expi es 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 compliant with County Ordinance No. 549. CEJ`f0—(9 A]�- ,�D r JOB ADDRESS AND LOCA�TIjOI Sl� -- Owner's Name -----J --- -- ---- Phone-- - -- ----- ------------ - �- - Address--------------- `5 3----------� 5�'1. ------------------ Contractor's Name----COIAI.G}i. ------ -------- ----- Phone Installa+ion will serve: Residence Apartment House [-] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __-.- Number of bedrooms - ----- Number of baths ---- Lot size -.-157. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Y- 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-------- ---------- l No �/ �]�New Construction: Yes L7 iso ❑ FHA/VA: Yes 2�—_No ❑ .,TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) K Septic T nk: Distance from nearest well__ ----Distance from foundation-__ 87---___,Material - ` -- No. of compartments-..__.._Z -. -_- -----.----Size--1/-X1_�-X- -•___Liquid depth._- _ _ Capacity 1 Z�----- Disposal Field: Distance from nearest well__--.SO---Distance from foundation------fQ-------Distance to nearest lot line.--�. __-... r 9 7 .( ---------------Width of trench. t� Number of lines----------- Len th of each line-_ Type of filter material---- Q.C.•_K_Depth of fiiter material-------IC?----------Total length----------/ -0-----------_------. Seepage Pit: Distance to nearest weft----------------------Distance from foundation-------------------.Distance to nearest lot line-_--------------- ph ❑ Number of pits.-- ---------------...Lining material------------ -------- Size: Diameter------------ .........Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation................._.Lining materia)--_.---------------------.---- -----. ❑ Size: Diameter. .- ------- ---- ------- ---- Depth-------- ------------ ------ -------------------Liquid Capacity- ---- ----------- -----gals. a - Privy: Distance from nearest well._.-- __.-....- - _ -- .-Distance from nearest buildin g ❑ Distance to nearest lot line----------- ---------------------------- - ` Remodeling and/or repairing (describe):--.- -----------_- ----------------------------- y - ------------------ ---------------------------------------------------------------------------------------- --------------- - ---------------- -------------- ............................................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__ r �% ..-_(Owner and/or Contractor) Y - --- -- -- ---(Title) ------- ---- (Plot plan, showing size of lot, location of system in relation to wells;•buildings, etc., can be placed on reverse side). FOR DEP TMENT USE ONLY l c APPLICATION ACCEPTED BY---- -_�. .-��--------------- -- ------------- DATE--------Ca < 1-- r.. ----- REVIEWED BY------------- - ------------ - ------- DATE:----------------------------------- - BUILDING PERMIT ISSUED-------- -- ----------------------------------------------------- -------- ----- ---- -----... DATE.-------- ------------- tera+ions and/or recommendations:___---_--------------------------- --------------- -------------------------------------- ------ -- - ----------------------- --------------------- ------------- ------- ------------- ------ -------------------- ---------- FINAL INSPE -- Date------- /- . 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California , Manteca, California E.N.9 2M 1-67 VpngVard Press i Tracy,California