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I-UKCJFW L ub,�: -----------------------------s-------------------------- APPLICATjON FOR SANITATION PERMIT Permit No. .� ..... .. ----------------------------------------------------- (Complete in Duplicate) / Date Issued ------------------ This permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health.District fora permit to construct and install the work herein described. This application is made in complia7e with County•.Ordinance No. 549. 1 ! f�/I TG f.4- CONN'" 0,4 It -kb3 �l`f.11� ,5-00 i/�.-.--OF JPR�CKZEL Is )013 ADDRESS AND LATI ---- Owner's Name ----------------- Phone Address-----. Contractor's Name...n AfV7rZQ_9--------51ET�_ V I CC Phone.. --•--•-•------- Installation will serve: Residence RT�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms _Z. Number of baths -_/---- Lot size --------------_------_ Water Supply: Public system ❑ Community system ❑ Private VDepth to Water Table -- _ ft. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam E] Clay Loam ❑ 1 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- --------- ) No New Construction: Yes E-'Iio ❑ FHA/VA: Yes ❑ No Q' TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well____5- ...-Distance from foundl- ation-J-Q-------___.Materia -e [ ET"� ONC ___-.---. No. of compartments----_ — Size-7..X/ :A-.-5 Liquid_depth.. 7..r.........Capacity--JZOP__-_ Disposal Field: Distance from nearest well- 5 --_-_Distance from foundation-----1P----.--.Distance to nearest lot line------ Number of lines---------/-----------------------Length of each line_.__IQ.Q-_---_-__.---.Width of french-------2l-/ Type of filter material_RQ C_K.__-Depth of filter material----._/_<7-----------Total length---------- --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- El Number of pits-----.__"____..------Lining material----------_-----------Size. Diameter------------------ ----Depth--------------------------------- Cesspool: Distance from nearest well-------------_--Distance from foundation--------------------Lining material______.-------------------______._--. ❑ Size: Diameter--------- ------Depth--------------------- ----------- -----------------Liquid Capacity--- ------------------------gals. Privy: Distance kfrorn nearest well--1----_--_-----------------------------------Distance from nearest building-------------.-----------------------_-_- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------- P Remodeling and/or repairing (describe]:__--.- __lA/4 _----INST�91-lr Q----- EF --- VA_S------&?Q-V ------- r----------------poar—I-0N_ S------�J.�------- 4- HF-.1 - eWJJ�RR -------- -E F� ''.-'-F�r.n(r4 nrs cri-Q f1------ - -- ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 s, and rules angulations of the San Joaquin Local Health District. (Signed)- ..� __-___--------------------(Owner and/or Contractor) By: -(Title)- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f i R .-- ----- ------------------------ DATE REVIEWED BY --------------- DATE BUILDINGPERMIT ISSN.IED------------------------------------------------------------------------------------ ---------------- DATE--------------------------------- Alterationsand/or recommendations------------------------ ......._-------------------------------------------------•------------------------------------------------------------- . . -------------------------•-------------------- - ------- ----------------------------- ---- -- ------------------------------------------------------------ ----------------•--------------------------------------- ------------------------------------------------------------------------------- ----- ------ -------------- -----------------------------------------•----------------------•-----------------------------------------------. FINAL INSPECTIO Da-te / ___-IS5�-�------ ------- ---- - - ------------------- - -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.