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FOR OFFICE USE: • ------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._a2 _. ------------- ------------------------------------------- (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, r 99---r70-06 JOB ADDRESS AND LOCATION-- _eope _ z�. _�I 't_h7- /_X.f- -,---------------- Owner's Name--------/ aXR_ra-------1;4�,��• Ei..0 er --- -- -- Phone----------------------------------- Address------------------------ 1/1�� ft�i�i�/ �_ - Ww_ t ------- -------- ----••---•--------•--------------•----•-----•- Contractor's Name------� _.: - G3 �`' ----------------------------------------- ------ Phone-----------------.-------------- -------------------------- - - Installation will serve: Residence [) Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: ` __ Number of bedrooms Number of baths __✓`Z Lot size _ � - '--------------------- -- Water Supply: Public system ❑ Community system ❑ Private ET"Depfh to Water Table AZ ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Q'o Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No J?r, New Construction: Yes @30'No ❑ FNA/VA: Yes ❑ Nom - =TY-PE,OF INSTAL-LATION-AND-SPECIFICATIONS:-.mr- _ w - _ ___ (No septic tank or cesspool permitted if public sewer is available within 244 feet.) �� l _ p k_ Septic Tank: Distance from nearest well- ..___...__ Distance from foundation__.0 Mafe 'al. __._._ hJ # �.,` rr�� 4 R - No. of compartments.--A---------------�.Size�1��_.�"_..�JI(,�-Liquid depth.-._�� N Disposal Field: Distance from near�t well.AM----_Distance from foundation_Z/P_ ___.Distance to nearest lot Gne_ ______; % f4 r13 ®� Numbor of lines____ ___________ Length of each line____-. ....-__ .Width of trenchX.-.-----------------_.__. Type of<filter material/-- Depth of filter material �, �___-_-Total length_- .�Q`____.._- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot line--.__----- __..... ❑ Number of pits----------------------Lining material---------------------.Size: Diameter------------------_ Dept h_......_.__-_--------- -----_ ' Ir Cesspool: Distance from nearest well-----------------Distance from foundation-----_--------------Lining I€material______....____.__.._..____---------- . i ❑ Size: Diameter--------------------- ---------------Depth-------------- ---------------------------------- .Liquid Capacity----------------------- ..gals. Privy:- Distance from nearest weft..-------------------------------------- ......._Dis�ance from nearest buildin ❑ Distance to nearest lot line--_--- 1 9 ------------ ------------------ ------------------------------------ ---------------------------- ---------- --------- ------- -- ----------------- Remodeling' and/or repairing (describe)-------------'.!_ -( ------- �91 -('_ t,/.S ✓..�77----- s ------------•---------•--- ------------ -------------------------- / f-- ------------------------ -------------------------- -----------------------------------------------:--------------------------------------------------------------------------------------------------------- ------ ------- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- 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 Joaquin Local Health District. ■ (Signed)---------------- ------- ( ! f'' L>�.l.. E ._.. —� �,.._ . :.--�-.•- - - -- - T -. _ - ---- ---- ---- ------- ------- ---- - 9w+rhr Contractor) BY:------------------------ -----------------------•- ----------------- ------(Title)---- - ' L �ir�1'1. ------ (Plot plan, showing size of lot, location of system in relatj to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----;_-1:1.-�----°- ------------------------------- --------------------------------- DATE----------L - .- REVIEWED BY----- ----------------- ----------- DATE -------------------------------------- --------------------------------------- --------------------------------------- BUILDING PERMIT ISSUED----- ------ -------------- -------------------------------------:---------_---- ------------ DATE------- ----e--�--- : t r ------------ -Alterations and/or,recommendations:_ ___dW----___.-..13 i- ----------Q-R-------aFi _.:----------------------------------------------4- CH ------ .r ------------------------------------ --- ----------------- -------------- --- - ------------------------ ----------------------------- -----•------------------------------------- -------- - ----------------------------------- -------- --- --------------- - --- --- - - - - - - - -------------- ------------------------ FINAL iNSP ____- -- - --- Date--------------- f.-`_ .."- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy, California i r.P.CO.