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FQROFFICE USE: J- --- ------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .2�.7� ------- ------------------------------------------ (Complele' in Duplicate) Date Issued -- ----- --------- ------------------ This Permit Expires 1 Year From 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 com liaace with County Ordinance No. 549- �Q� Zc�p.— �L(�— 0 ' _2_of Uj . V�4- 77--a , r 1 JOB ADDRESS AND LOCATION_--IaL_------ ----- --_-_------_-�RftC ------ -10�--�-}J - ----------------------------------- Owner's Name--1--o-Up-j � ------------------------------•-------------------- ---- - Phoned' ----------- Address--------—&ftMZ------- Contractor's ---------- Address---------&frnZ---•-- Contractor's Name-- ------------• --- -------- ------------------------------•-- -----•-------•--------------- Phone----------------------------------- Installation will serve: Residence•< Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I---- Number of bedrooms _9�n- Number of baths -_,----- Lot size --------G--- -OM$----------------------- Water Supply: Public system ❑ Community system ❑ Private)< Depth to Water Table -_.----- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ I Previous Application Made: (If yes date--------------------1 No New Construction: Yes ; No E] FHA/VA: Yes ❑ No ❑ TYPE .OF INSTALLATION AND.SPECIFICAZIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wej :fl 4 Distance from foundation_-- ----------------------------------------------- No. uCR -____----__-------- --.No. of compartments------�--------_-__--Size-qk_5-_)(-...'-�.......Liquid depth---------- ---------------Capacity------&Q-��' {V Disposal Field: Distance from nearest well AREA-$-Distance from foundation.-OX-FT----Distance to nearest lot line-• -Fl- 1 Number of lines-___---r�->---------------------Length of each line-----612--FT---------Width of trench.--.-r�•.!'�,-t�0-l�S---- Type of filter materialSQ___COC�---Depth of filter material-----V.9__1tr. ��Total length-------- -L-.__-- T-_------------- 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 material-----__------------------------------. ❑ Size: Diameter--------------------------------------Dept h--------------.:. --------- ------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weEl-------------------------------------------------Distance from nearest building-____-____-----------_---------------.--. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------- -- Remodeling and/or repairing (describe):------=-----------------------------------------•------------------------------------------------------------------------------------------------------- ------- - ------------------------------------------------------------------------------------------------------------•-------•---------------------------------------------------------------------- ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------'------ 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 ules nd regulations of the San Joaquin Local Health District. �+ (Signed)---- 111t/t� ---------------------------------------------- --------------(Owner and/or Contractor) BYr'---------------------------------------- -----------------------------------------------------------------------------------------(Title)----------_-------- ----- - ---------- �-----_.-__.-.� -------- (Plot ------(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 ----- ---.-- -------------------- DATE------4-'-VX7-.o-� ._ -- -- ---------------------- REVIEWEDBY ------------------------------------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE------------------------------------------------------------ I Alterations and/or recommendations---------------- -----_------------------------------------------------------------------------------------- ------------------•------------------------- ----- 10 ------------------------- --- ---------- --------------------------------------------------------- -------------------------- --------------------------------------------------------------------------•------------------ -------------------------------------------------------------------------------------------------------------------------------------------•----•-------------------•---•------------- ------------------------ -------- ------------•--•------------------------------ ----------------- - - ------ ----------------------- ------- -----1---- ----------- •--------- -- --•----- ----------------------------------------------------- ------------------------ ------ ------ - ----- ------------------------------------------------- ----------- ----------------------------------------- ----------------------------------------------------- FINAL INSPECTION B :--- ----- -- ------ - - --�-------- Date--- --------------------------------------------------- S ---- -S JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California �. Manteca,California Tracy,California r.P,CO.