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rUKUl ILt USt: ------------------------ ------------ -------I--------- r t APPLICATION FOR SANITATION PERMIT Permit No. _... ..... --------------------------------------- ---------------- (Complete in Duplicate) j tate Issued Date Issued -------------�G- �� I This Permit Expires i Year From D Id �, S ' Application is hereby made to the San Joaquin Local Health District fora Z e w 0.16-0e"`O This application is ode in ccomplian-ce with County Ordinance No. 549, permit to construct and install he work herein described. 1�� /,� � ' JOB ADDRESS AND LOCATION__F___- 1-D..-_- 1L�Tf ] �` j� /�- � ----------- " � - - -1 R1Dom_ Owner's Name------------------ L ---------'� -------• V�f ��- - t } Address.--------- :1iox ES CA L !� Contractor's Name =.1�= 1�!1 ./ � -1�---------- --------•--- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6 Number of living units: __j----- Number of bedrooms=-.1--- Number of baths____ Lot size ------ ------------------------ Water --------------- Water Supply: Public system ❑ Community system ❑ Private .B`�Dep#h to Water Table .3 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--------------------) No New Construction: Yes 93--No ❑ FHA/VA: Yes f]'`No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: tank orcesspool-permittedvif public sewer`is'available within-200-feet. = - I } _: Septic Tank: Distance from nearest wefl__._.S�_..__Distance from foundation,-_ ---------Material---COAIC _ _ No, of components = Size ' ---Liquid depth---------------------- Capaci#y -' Disposal Field: Distance from nearest well—5-0 from.-f�ation___��__-__._.__-Distance to nearest -_. _lot line__ I ©� Number of lines-1____--Z-----------------Length o s e line--c. ------ ��---•Wid#h of trench--``-----�`------------�---�i Type of filter material--- - X_--__Depth of filter material---1-�_�`-_-----Total length_-_.____________�I -------- Seepage Pit: "Distance to nearest well----------------------Distance from foundation-------------------_Distance to nearest lot line_____-______-_--� ❑ Number of pits--t------------------Lining material----------------------Size: Diameter-------------__ ----Depth---- --------------------------- Cesspool: Di ------.Lining material---------s#ance from nearest well-----------------Distance from foundation_...___.----- i - �---------•--- ----- -- ❑ Size: Diameter I---------------------------------Depth--------------- --------------------•-•-- ----------Liquid Capacity Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building......------------------------------------k ❑ Distance to nearest lot line ------------------ -- ----- - ••------ -------------•--------------------- --------------------- - Remodeling and/or repairing (describe):-- _ ------------------ .___�_._------ fi t" ------------------------------------------------ -------- ------------------ ----- --------------------------------------------------------•---------------------------------------------------------•-------------- -------•------------------------------------------------------------------------- -- ------------------------- ------------------------ ------------------------------------------------------------------- -------------------------------------------------- --- . at I have red this ion and that the work will done I hers, Statcertify taws,and rules andYaregulations of tte San Joaquin Local Health ctn accordance with San Joaquin County{ ordinances, , (Signed)-.- ------------------------------=--- --- - ---� --------------------------------------------- -- / C ----``==-�----•-- --'-- ----- ----'-`-�------ --- -�--'�`�--"F`-....''�..=` �------' - Winer and/or a .r _�,•�r o nt actor (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. t i I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------. 1 !R.-Q REVIEWED BY - - --------------•----------- _ - . e DATE E -------- --------------------- ----- DATE ---------------- - PERMITISSL.IED------- --------- ---------------------•----------------------------------------------- --------- DATE Alterations and/or recommendations:_ - -- ----- --------- --------------------------- _ ----- ------- --- ------ •---- . ----------- ---------- -----------------•------------- ------------------------------- ------------ ----------- FINAL INSPEC`T1~ "° .17�1.�� --: '- Date ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellion Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.RQUp - - '