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FOR CFFICI UAL _____-_________ APPLICATION FOR SANITATION PERMIT Permit No. __l h ..._... -------------- ------A-1--- -- (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 ncoompliance with County Ordinance No. 549.,E r JOB ADDRESS ANDCATIOt R-N1��-------0 [' 01v--- _ _).�"LI -----� --�---------------- Owner's Name---CfAtFZ-�"-'----------13/9t4x-S----' -------------------------------- ------------------------------------------- Phone------------------------------------ Address---------------- 1 --------13 -----10-: _7----------4_ H— R!-P-'----------------------------------------------------------------------------- Contractor's Name---------PWIVE�i_K '-------------------------------------------------------------- ----------------------------------------- Phone------------------ --------------- Installation will serve: Residence F Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: j---- Number of bedro fns3_. Number of baths _1_--_ Lot size _1.AR_X-----1.4. ---------------------------- Water Supply: Public system ❑ Community s em ❑ Private ❑ Depth to Water Table -------- 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 New Construction: Yes E�-'No ❑ FHA/VA: Yes t--*'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puO sewer is available within 200 feet.) P Septic nk: Distance from nearest well_<7 .W_Distance yfrom foundation-__ _ _ Mat ria---__ _ __ _ No. of compartments_________________._Size__�f r1_�D_X._�.__Liquid de th____. P p y �Q 49_ q [ Ca acit -J-- ------- DisDisposal Field: Distance from nearest well__ �_-Distance from founda 'on.__ _ p 1.V__-.__.._.Distance to nearest lot line____- ______._ �i [� � __________Length of each line_ __^�•�_�S..Width of tfench.___.-�__.�_.:.__ Number of lines______ ____ _______ _ Type of filter material___ �_� __Depth of filter materiaL_____1e_____Total length__._._____J, ---__-�___-__--_ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line__-..._.______ O ❑ Number of pits----------------------Lining material----------_----.-------Size: Diameter-----------------------Depth-----........------- ___________ 3 Cesspool: Distance from nearest well----------_____Distance from foundation--- --------------_Lining material___________------------------------- 4- 0 Size: Diameter------------------------------------Depth--- -------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____ ---------------------_----__Distance from nearest building______-._-_____________--. ❑ Distance to near - - - - ------ - ------------------------------------------ Remodeling and/or repairingdescribe):------fDZ----- ------- - ----- - ----- 1t'/4 - ---- f 1 r DC--u-- --------------------- y ------ 1� ? - A -------Or-------►°3 R-A.� d— _IV G----------c 1 --------"i a R- ------------- ------------------- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County �l ordinances, State laws, and�rulend regulations of the San Joaquin Local Health District.2 (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.------ t 4 `---------------------------------------------------------- ----- DATE---------- _ -� REVIEWEDBY------------------- ---------- ----------- ------------------------------------------------------------------ DATE--------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------. DATE------------------------- ------- Alterations and/or recommendations:----------------------------------- ----- ------------------------------------------------------------------------------------------------------------------- ----------------------- ------------- - ---- ------ ------------ --------------------------------------------------------------------------------•---•----------- ---------------------------------------------- --------------------------------- - -- ------------ --------------- -------------------------------------------------- -------- ------------------------------------------------------------- -- Q-� - f - -- - 1 ------- Aft"�° - FINAL INSPECTI i �� -- Date--------- P_ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.