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1-UK UFFICE USE: ------------------------------------------- -- -- --------------------------------.- -------------- APPLICATION FOR SANITATION PERMIT Permit No. __2_q_S�_ --- ------------------- - ----------------------------- Duplicate) This Permit Expires res 1 Year From Date Issued Date Issued � l / 6 t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe. Thjsamllcaflorii is¢�a) Inc�✓ I''8 ce w" h County Ordinance No. 549. LS.S4 !n! JOB ADDRESS ASL-QCATIO t 01 - ----•- Owner's Name / CSC/f 6 Phone. ---�---?- ---•-- -------------� --- - -- ------------------------------ Addressl - ------------ --------------- ---- C / ¢ Contractor's Name-- i ame Phone ... --------- ------- ---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---�_ Numb#r of bedrooms___ Numb�ofths�--- Lot size ---- ______________ - -Water Supply: Public system ❑ Commdnit s stemy y ❑ Privateh to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan I] Previous Application Made: [if yes,dote___t-------:------- ) No ❑ New Construction; _�es ❑ No ❑ FHA/VA: Yes ❑ No ❑ —TYPE-OF-INSTALLATION-AND, SP,ECIFICATIQNS.:�: (No septic tank or cesspool permitted if public sewer is available within 200 feet:) Septic 7 distance from nearest welL_60--------Distance from foundation__. :�----- - No. of compartments_....-.t)L—----- -----Size-_l _. !1 ----Liquid'.depth--- ______________capacity Disposal Feld: Distance from near well.---:--.--Distance from foundation__----------- - nce to nearest lot line__C5_ Number of, lines___ - /Length of each line---/-- .. _-« th of trench..-- -- ri f ------- ----- -- Type of r mite SeepagePit: Distancef tloenea est Iwekl_p--_-� �epth of filter material-------/�f{' Total length____ -41 f,�� .____Distance from foundation_______________-_.Distance to nearest lot line--_____________ ❑ Number of pits.- ------ f-.-----_Lining material-----------------------Size: Diameter--------------------_.Depth-.__...--------- �. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------..___--________. ❑ Size: Diameter --- 4--y--------- ------Depth--------- - ----------------------- -- --------- Liquid Capacity---------------------------gals. Privy: Distance from rearest well-------------------------------------------------Distance from nearest building--------------------.-- ` ❑ Distance to nearest lot line---------------------- - ---------------------- ----_--- , - ------------------------------------------------- ------------------------------ Remodelin or re airin doscribe :----_ ' `� p 9 ( ) • — ------------------ ------ - ', = --------------------------------------------------- ----------------------------------------------------- -==------------------------------------ --------------------------------- ----------- 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 I ,' and rules an regul tions of,the San Joaquin Local Health District. (Signed ---. rt f. q -��---- __________ Owner and/or antra BY: ;, --------------------------------------------(Tale).:. � -- ---- . _�. . - (Plot plan, showing e f lot, location of system in rale 1 o ,wells, buildings, etc., can be placed on'reverse side). FOR DEPARTMENT USE ONLY APPLICATION iSCCEPTE61BY .T_ ------ - I/� _ DATE---- G - ---------- vi REVIEWED BY------------------------- --------------- -- ---- -------------------------------- ------------ -- ---- ------------------ BUILDING PERMIT ISSUED `------------------------------------------------------------------------------------ DA•TE ---------------------------------------------- ------------------ �,.�. AI#erations and/or recommendations:-----------------`—�------------------ -- - -------------------------------------------------------------- • ----------- ----------- ------------------------ ------ ------------------------------------------ ------• --------------------------------------------- ------------------------------------------------------------------------------------------ -------------------- ---------- ------------------------------------------------------- FINAL INSPECTION BY . - --- -- --- - - - -- ..�` - . *----------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT _ _ r 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California