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I-UKVI-l-K-t USt: � Ow aL,µ f------ -- ------------ -- __________________ ___________________________ __________ APPLICATION CrFO SANITATION PERMIT Permit No. --------------------------------------------------------- {Complefe 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN OCATION-- f D Owner's Name ftv�_ W_T,/l.l - Phone Address_........ �� ------ -✓--p-- ------ --'---r-------------------------------- Contractor's Name--------------% -...{ 8W_[GAY-------------------------- --- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence ®'�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/_ Number of bedrooms_ Number of baths _l.-_ Lot size -//el!�, _ _-___.__________---.__ Water Supply: Public system E] Community system El Private �pth to Water Table !OQ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe 0-14ardpan ❑ ' Previous Application Made: (If yes,date...._}.............) No New Construction: Yes ❑ No e- FHA/VA: Yes ❑ No Z;... TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if,public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_.._________--.-____---_-_______..___-..___.-.. No. of compartments------t -t------- Size--------------------------------Liquid depth---------------------- ---Capacity-------------- Disposal Fiel Distance:from-.n'earesf a : istance from foundation_';Pf---------Distance to nearest lot Ime_�_ _-_-- Number of lines____.___f__ t ------ Len th of each line____ �P� Width of trench__ ----�------------------------ --------------------------- Type _______________________ AP p g �; -W . Type of filter material _ /CpDepth of filter material---./ . -----Total length___-_ __________________________ Seep geill:Pit Distance to nearest well------_---------------Distance from foundation-------------------Distance to nearest lot line----------------- p\� gfi.q iXf Number of pits----------------------Lining material----------------------.Size: Diameter------------- ---------Depth-.------------------------------- Cesspool: / Distance from nearest well-----------------Distance from foundation....................Lining material_____--_._.___.__._.______.________ V ❑ Size: Diameter-------------------------------------Depth------------------------------- ------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well __---.----_--____Distance from nearest building________________________------------.-.-. ❑ Distance to nearest lot kne----------------------- ------ Remodeling and/or repairing (describe)-----------------s� - ------,-- --------------------- -r--------------, -------------------- ----------- ------------- .--------- --- ---- -------------- -------------------------- -----TT-----Y�"' - .�-T�7CT---- - --- -•-�-- --/- '-- --- ------------ " ---- - - --- y-,,-� �/�j-�-C - ^� - ----------- � �- ----�--- ---- --- - fJ �'`1 `L- -- -- c _. / __. I hereby certif t I have prepared this applicati 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. t-77 (Signed)--------------------- -✓ -- -------- ---- ------- - - ----- -- -- ---------------------------------------------------(Gwemedm '/or Contractor) By:-------------------------------------------------- ------------------ `__ ----------------------(Title)- (Plot plan, showing size of lot;location of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---- ------ -------------- ----- / DATE--------4V----- -------- ---5------------------ REVIEWEDBY-------------------------------------------- ---------------------------- ---- -- ------ -------------------- DATE--------- BUILDING PERMIT ISSUED------------- -- ATE --- --------------- Alterations a d or reco a ations: - -� -------•---•------- ----------------------------------------------------- ----------- ----------- -------------------------------------------------------------------------------------------------------------------------------- --------------- FINAL INSPECTIONBY:-- - J -------------------------- Date_ ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street r 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California r.a.C o.