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----------- -------------------------------- .F d ------- ---------------- -------------------------------- APPLICATION FOR SANITATION PERMIT ' :Pei mit .No. . i (Complete in Duplicate) ------------------------------------------- ----- - - --- This Permit Expires 1 Year From Date Issued 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. 4riM r" JOB ADDRESS AND LOCATIO "".END Owner's Name_ l _ ( ----------4A_K Phone ------•-------- Address..--------- ---`)'�-----3---�------�`�--�SC-- ---�J--�--�J----------• m-rC�---'----------------------------------------------------- G - - - Contractor's Name__-0-WtiER•- -" Phone -•------•------- k Installation will serve: Residence = ❑ Apartment House E] Commercial [I Trailer-Ge>ir# H' Motel ❑ Other 0Number of living units: _"Number of bedrooms __2-Number of baths _I�Lot size ------- ------------------ t4 E € t Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table "/7—ft. Character of soil to a depth of 3 feet: Sand ravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: (If yes,date____------------ ____) No New Construction: Yes Na ❑ FHA/VA: Yes ❑ No TYPE OF.INSTALLATION AND SPECIFICATIONS: Q" (No`sdptic tank or cesspool permitted if public sewer isva ailable within 200 feet:) - �.,_ Septic Tank: Distance from nearest well---14 ----Distance from foundation--------------------Maferial_!;:.P �� Y No. of compartments---_--- - Sizl�X!P-_2 b--------Liquid depthCapacity �p0 z— Ca acct --f - -•---------- I Disposal Field: Distance from nearest well-_/p.Q---Distance from foundation-_1Q __ _ __.__"__.Distance to nearest lot line____.`.?_ Number of lines_-------- �- Length of each line l O <<----Width of trench------•� __!-� r Type of filter materiaL___��C—Pev --Depth of filter material------/17__" ___--..Total length---------------/�1J"""__-_-- Seepage Pit: Distance to nearest well-----_--------------__Distance from foundation_______________.-_- Distance to nearest lot line___--"""_____--_• ❑ Number of pits-- ------------------Lining material-----------------------Size: Diameter_'- -------------_---Depth ------------------------- Cesspool: Distance from nearest well----------_------Distance from foundation__-._-_.__.-______-.Lining m•aterial_...__-.__"__-." 3 --------------------El ------ I --------------------Diameter Depth - -Li uid Capacity- ------gals. Privy: Distance from nearest well-------.._--------_---------------------- ------Distance from nearest buildin ❑ Distance to nearest lot line------- 9 - Remodeling and/or repairing (describe):----- �.----REQS----�T'----------P"---------'--�------- ----------- --------------------------------- -------------- '— FtB-T-- T1 42$a__r4_6�_ ------------------------------------ ---------------------- -- # -------------------------------------- - ---------------------- -------------------------------------- ---- - --------------------------------------- I herebycertify that I have P 9 pP q --- --- - -- --- ------ - - - ------ -- - - -- - y pre ared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed)---------- - --------------------------- - ---------------------- and/or on it Y - ""' (Owner a o t actor ..- -- - ----------- B -- -- - -- - ---------------------- (Plot - pan, s owing size of to , location of system in relation to wells, 6uildings,'etc., can be placed on reverse side). 1 FOR D�ARTMENT USE ONLY t APPLICATION ACCEPTED BY------7+_c_R-v REVIE=WED BY------ - ------------- � --------------------------------------------------------- DATE--------- . "A�-------------------- • ----------- - - - -------------------- ------ DATE-----------------------•------------------------------------ BUILDING PERMIT ISSUED ------- ----i-------------- ----- -- ------=----- DATE = t Alterations and/or recommendations:_�__.-.__-______________ ----------------------------------------------- g---- ----- --- - --------- 1 --------------- ------- FINAL 1NSP Date !✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California _ Tracy,California F.P.CO. -