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FOR OFFICE USE: a ._ - - ----------------------- --- _ _---------- ------- APPLICATION FOR SANITATION PERMIT `' Permit No. _ ------- (Complete in Duplicate) 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 described. in compli ce with County Ordinance No. '549. This application is made JOB ADDRESS AND LOC ION-------------- I lir ------I-1.�------- --Z----- Owner's Name------------------ •- 0_N_�1.4a------------NKS.0145-------------------- - - ---------------------------------------- Phone-------------------------------- • I�x w + Address----------------•----- .-_ 1. --- Q�..A•------� -----------R-1--��--- ---------- - Contractor's Name--------Q_w1j�&-------------------------------------------------------------------- Phone--------------------•----- ------- Installation will serve: Residence 2"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I _._ Number of baths z— Lot size "_19-cfkF�--�_aP- -•------------------------ Number of living units: -]---- Number of bedrooms .� --- Water Supply: Public system ❑ Community-system ❑ Private [Depth to Water Table I - 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------ -------- 1 No Rl"' New Construction: Yes ?!r No ❑ FHA/VA: Yes 29�' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic tank or cesspool permitted if public sewer is available within-200 feet:) Mata�al_ 4/1l _R_ T ------------- r - Septic T k: Distance frorn nearest well__-Sr).--_Dista ce from J undation"____!9 �_ m/fl_ �f - Liquid de fli"''y .__a.-_- "-.Ca acit No. of compartments--------- ""-- ------- p y--- `'5--- _----- om nearest well------ aP_Dis ante from foundation----f0,_": __:.Distance to nearest lot lin ------------ Size b----- q p• Disposal Field: Distance from P� Number of lines_-_------ ___--Length of each line_ ' - � Width of trench___ "- ------ ------- ---Total length______________ /15-0-- ------------------ Type of filter material U_��_--_-Depth of filter material_-_._ Seepage Pit: Distance to nearest well---------------------- 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_____..-._._" -____"_-___- _gals, ❑ Liquid Capacity- ------------------------- ,, . Size: Diameter------------- ----------- --------Depth------------------------------------ --------- - g t " Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-___-______---_-__----------------------- ❑ Distance to nearest lot line--------- -------------------------- -- ------------------------------- ------ ----------- I I 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 County ordinances, State laws, and r s and regulations of the San Joaquin Local Health District. 4 5i ned ----------------------•----------------_-(Owner and/or Contractor) ( g } - -------------------------- -------------------------------- rz ------ (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_.-.T1K:1 ,--------------- ------------------------------------------------------ DATE--------�z--T 7-------- fREVIEWED BY-------------- --------=----------------------------------------------------------- --- -------------------------- - ------ DATE------------------------------- ---------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations---------------------------- - ------------------------------------ ---------------------------------- ------------------------ - ----------------------------------------•--- ------------------- ------------------------ ------------------------------------- --------------------------------- ----- ------ - --- - --- FINAL INSPEC = Date--------- -------(�1- ' --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Wa:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California T Stockton,California '� -- F.P.rG.