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FOR,OFFICI:,USE: ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) —14 Z1LV "� -------- This Permit Expires 1 Year tFrom Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and inffall-,the work herein described. This application is made in compliance with County Ordinance No. 549. ' ;,N6 btw c�4"r o f i JOB ADDRESS AND LO ATION---_��p ___I�l`1"?jr} --------V-QN-------D - _�_ _EN. ---------------------` _ Owner's Name----------------- __��rr:_---- - .. Phone------------------------------------ Address-..-. ------ ------ -------------------- o/-------r�-_-_ � AIT . Address_ w j-� r",;� ---- ✓�--`----�`--`-- ---------------......--------- .----•---...._.- Contractor's Name__ T'CA-_..-51EPTIC.--- -;l --------I-------------------------------- ---------------- P'ho'ne----------------------------------- Installation will serve: Resident' ❑ Apartment Howe ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ---{ ___ Number of bedrooms _n ___ Number of baths _ - , [�___ __________________ -- � r �=-- Lot size --- -- ----- - Water Supply: Public system ❑ Community system I-] Private rj--Depth to Water Taber- - ft._/o Character of sail to-a depth,-of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe E] Hardpan El�j �"-V'A Previous Application Made.-T(If yes',dale---------------___.) No E�' New Construction: Yes No ❑ FHA/VA: Yes ❑ No JD-' TYPE OF INSTALLATION AND SPECIFICATIONS: 10 [No septic tank or cesspool permitted if public sewerfis available within 200 feet) -. Septic Tank: Distance from nearest well------ from four anon _______________ laferial_____...____ ....____.____._ ..______- Til J��— No. of com artments--------------------------Size--------------------j- VI Li" uid depth----{--------------- 4-- Capacity.-------- --- -- --- �� pr q . - Dis osal Field: Distance from nearest welL___S7C)_____Distance from folrlti.on' ~� p ___.__��_.__._.Distance to nearest lot line_______.____ � 'rjAl� Number of lines-----------/____._-------------Length of each hne _��"�`�? -------------Width of french._.___.y�.- _r 190D Type of filter material___ Depth of filter�maten'al_.-��..._._._..Total length____- -'____Irv� Seepage a e Pit: Distance to nearest well.-_/0_0._.___Distance fromfoundati•on__ ' �_______. istanrcen/1to nearest lot line.___ -�___ _ ts Number of pits-------- ________._Lining material_,A0 - i__.Sizef: DiaPneter_�� .lf _.Depth_____ - -------- Cesspool: Distance from nearest well-----------------Distance from foundation ._ rLining material_______-_____________________.___-_-_. ❑ Size: Diameter------- --------------------------• p ---------- Liquid Capacity----------------------------gals. I I .) Privy: Distance from nearest well__________________ _____-..______._._._____ _-Distance from nearest building__________-________________.__._..__.._ _6 ❑ Distdnce to nearest lot line--------------- __._ ---- --- -------------- ------ f----------I - ---------------- 13W(I J Remodeling and/or repairing (describe}:--- - ------ -------------- ------- --------- ----------------------------------------- ------------------ f f --------------------------------------- -------------------------------------------------------- ------------------- ----------------------------------I---- ' ii 11 � � ---- I herebyc tify that Iiavoprepared this plica�tio and lthahew t•tork will be done in accordance with San Joaquin County ordinances, Sfa la , and--F les re ations of the San Joaquin Local Health District. T- (Signed)- ----------------- -- ----� `--------------------------------------------------------------------------=------15-----{Owner and/or Contractor) By:------------------------------- ----------- -------------------------------------------------------------------------------------(Title)...I " r --(Plot plan;-showing"size of lot,location of-System in relation to wells, buildings, etc., can be placed on'reverse ssid`e). FOR DEPARTMENT USE ONLY W APPLICATION ACCEPTED BY------- sC' ------- ---------------------------------------------------------- DATE----A/___"-;30__7_[2----------------- REVIEWEDBY-------------------------- ---------- ------------ ----------------------------- --------- ------------- ------------ DATE------"---------- BUILDING ------ 'BUILDING PERMIT ISSUED------------------------- -------------------- ------------------------------------------------------- DATE-� -Z ---------------------------------------------------- Alterations and/or recommendations:_-_----._._ f "` ----------------------------•--•------• ------------------------------------------------ -•----------- ---------- -•------------ ------------------------------------------------------ ------------------------•--------------------------------------------------------------------------•-•---------------- --------------•------------------------------------------------------- ------------------------------------------------------------------------------- ---------------------------------------------------- ---------------- ---- -------------------------------- - --------- --- —.._ FINAL INSPECTlb" _-_- ----- Date________ _ ______ — .. ---------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.