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FOR 04I(fE`t7SE: 1 -------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,L_�?._s�_!�._ __ (Complete in Duplicate) Date Issued ---`7-� -1;bl 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 descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION r 'r- -- •----- Owner's Name------------------P-0_VVAH-1)-------J-----------M-EINKIAG --------------------------------- ------- Phone.-._..--------------------------•--- Address............... �•------2---"----}�-!x.-------6��---------- 1 T--Co---'-----------------_--------- ---------------------------------------------------•-------...- Contractor's Name_. Ri�•�-E ----------- Phone------------------------- -•------- --------------------------------------------- --------------------------- Installation will serve: Residence R1 Apartment House ❑ Commercial ❑ Trailer Court ❑/Motel ❑ Other ❑ Number of living units: __f-._-- Number of bedrooms--- Number of baths /--.- Lot size �.y ��--�-----_------------------- Water Supply: Public system ❑ Community system El Private � e/,epth to Water Tabl __ 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 2--_-New Construction: Yes ®rte❑ FHA/VA: Yes ❑ No 2—' TYPE OF_INSTAL_LATION AND_SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tan Distance from nearest well---�- ----Distanc from � fcundation___/C?.........M1�ater�ial-�-G?"C�.� [T�----_---.. No, of compartments--------�---------Size--- Liquid depth___ ------Capacity_ W= Disposal Field: Distance from nearest well----- Distance from foundati n.----162---------Distance to nearest t line-5 tr,� [,/ Number of lines--- -__.-_-2--------------------Length of each line-- -+-4-Z.--.Width of trench...--- __ __-_- ----------- - - V} Type of filter material- O-tom -. .-.Depth of filter material.-.-.-- -Total length - � --------.--__--_-._ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------:Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material------------:-----------Siie: Diameter----------------------. Depth--.------------------------ - ._ 2. Cesspool: Distance from nearest weli-----------------Distance from foundation--------------------Lining material-.--.........-.------------------ ❑ Size: Diameter----------------- --------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ______________----------------------------------Distance from nearest building-----...-----..-------------_-------_._._. ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------- ------------------------------------------------ Remodeling and/or repairing (describe):------ ---------------------____- ---------------------------------------•----------------------------------------------------------------------------- ; --=----------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ---------------I- ---------- -------------------------------------------------•-•---=--------------------------------------------------------------------------------------•----------------------------------- 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 rules and regulations of the San Jqaquin Local Health District. (Signed _ -....-.Owner and/or Contractor —'By: — _ -1-4- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------�-R!D---- ----------------------------------------------------------------- DATE-_. -- - _;Z3_-_6/ REVIEWEDBY------------------------------------------- ---------------------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------ ----------------- ----------------------------- DATE.------------------------ ---------------------------------- Alterations and/or recommendations----------------------------------- -------- - -------------------------------------------------------•------------------------------------=------------------- -----------•---- -------------------- ii--- ---- ------- - . -------------------------------------------------------------- ---------- ----------------------- I - - -------- - _- -- --------- ---- --- - ------------- ----------------- FINAL INSPECT - -- Date------ -- - 40 . �0 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California