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FORIOFFIC�IUSE: A- -------------------------------- ----------------•-----. ------- ----------- --- -- >,._.._____---- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- ---- ----- ---------------------- (Complete in Duplicate) ff 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. This application is made.'' mp iance with ith County Ordinance No, 549. C�3 A lop A .,�013 ADDRESS AND LOCAT`Io �_.__ �bwner's Name------------------ ------------LE--------------t;-�_Hap-------------------------------------------------------------------------- Phone--_------------------------------- -Address___,F-----------RTES_. A T ---------------------------------------------------------------------- Contractor's Name ---- -- -- *N%-I!------- ------------------------------------------- Phone----.... ------------------- - --- -- Installation will serve:-Residence ®~Apartment House Ej Comffi�)FcO�E] Trailer Court E] Motel ❑ Other i I le'l Z�, Number of living units: Number of bedrooms -2--- Nurriber of baths _/--- Lot size ---------- 9 -40- Ir op/ Wafer Supply: Public system E] Communi y-s�!tem El Privafe j?/ Depth to Water ft. PIP er Table V f Character.of soil to a depth of 3 feet: Sand ff.r-Gravel E] ndy Loam El Clay Loam E] Clay Adobe ❑ Hardpan E] Previous Application Made: (if yes date_--- No Pj�-INew Construction: Yes EJ-1 FHA/VA-. Yes E] No Q-- TYPE,OF-INSTALLATION-AND-SPEC I FICATIONS (No septic tank or cesspool permiffied if public.sewer is available within 200 feet.) Septic,Tank:` Distance from neerlsf well_,_')A -------Distance from foundation---/ --------Materi i----RED-W.00 b -_-s jfil -.- - - 15;�P�2 No. of compartments_..____--��7 Size_3X_'7--- Liquid depth___ --—------Capacity— Ej- sl _ Disposal Fi6Id.-.-'"—Di§t;<from nearest v�.'6114J0._`Disfance from foundation----1_0--------Distance to nearest lot line.,_:��—------ -r---- Depth of filter material------J-C-/-----------Total length-------------------75------------- Number of lines___-_______ --------------Ler�gfh of each line_____7S----------- Width of trench.____.____________ Type of filter material Seepage Pit: Distance to nearest,'well-------------- --------Disfa'nce from foundation--------------------Dsfance to nearest lot line--._---______.___ ❑ - � Number of pifs---- --------------Lining material-----------------------Size: Diameter----.---------------_--Depth--.------------------------------ Cesspool; Distance fi-cffi nearest well-----------------Distance from foundation____.____.____.___.Lining materia!__._._.______.__-_____..____-__--._ 4�40iil� I.,it --------------------- F1Size:-7iDia-mefer--------------- ------- ---------------Depth----------------------- ------- - ----tAL---------Liquid Capacity------------------ - - ---:gals. Privy: ince ncg,from nearest well- .._..________________________________________Distarce from nearest building____-__--_._..______________..____._.._ --------------------------------- - --- ------------------------- El Distance #o nearest lot line Remodeling'and or repair ing,'Ides1cribe):----------------------------------------------------------- ------------ ---------------------------------------------------------------------------I --------------- --- ----- ----------I -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------- - ------------------------------------------------------N--------------------------------------------------------------------- I 1 9- 1(hw -------------------------- --------------- ------ ---------------------------------------------------------------------------------------- ------------------------------------------------------------------ 1 hereby certify fhat,irlhave-prepared this application and that the work will be done in accordance with San Joaquin County 47 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------- -------------------t-------- ---------------------- ------ -------------------------------------------------------- - ------------------------{Owner and/or Contractor) V, - -- ----------------------- --- ---------------------------------------T-------- sho (Plot wing size of lot, ocaffi , of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------.--- ---- -- ---------- ----- ---------------------------------------- DATE--------- , —-------------- REVIEWEDBY----------------------------------------- ------ -------------------------------------------------------------------------- DATE------------------------ BUILDING PERMIT ISSUED------------------- ----------------------------------------------------------------------- ---------- DATE Alterations and/or recommendafions.__&0-.TF_' ......C_qA.b(&F_= - _1hf-----1��_ .jo A=------------------------------------------------------------- - -------- -- - - - ---------------__-----------------------------------------_m------------------------------------- ---------?_ ---- ----- ---------- -----------_----------- --------------- ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ------------------------------- ------- •----- _ - ----------- ---- ----- ----------------------------------------------------------------------------------------- ------------------- - ---- -------- -------------------------------------- --------------------------------- ------------------------------- -- FINAL INSPE ON BY- Date--- ------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.