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FOR OFFICE USE: ----------------------------------------------- -------- rr}} ________________"___--_..-__----_-_---- ---_"-__----- APPLICATION FOR_SANITATION PERMIT Permit No. L'J.2zllc�_ ----------------------- -- -------------- ComP lefe 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, ,� JOB ADDRESS AND LOCATION 1 ---- - !�,- - �1-y`/ Gl'�f 'E--------- p Owners Name-------------- Owner :_ _ =E}`,Y_�l'-/_ P ;----- r� __—__7-- -------------- Phone- a._`�_q Addre ------ -------- � .�' ' ----------- Contractor's Name------------------ ------6p-e_1111Phone__ i Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ i Number of living units: ___f__ Number of bedrooms Number of baths Lot size ____ --_________-__-_ Water Supply: Public system ❑ Community system ❑ Private 10 Depth to Water Tablec�— ft. r I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,K Clay Loam-[] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,da#e------------J.._._-_I No New Construction: Yes [N No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: LL (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septti�ic,,�T �` Distance from nearest well----16---------Distance op found)tion------lff__-------Material_.-_ No. of compartments._._._.______-_-__Size_.- 1 -1 L --___Liquid depth___.-- z�_____Y__. Disposal Field: Distance'from nearest well------laf/_.-_.Distance from foundation__.....i_ -_-_-Distance to nearest lot line__._5`________O Number of lines.--.,�____________ _ Length of each line_- - _ __:_ Width of trench-.-t?_ -�_____-_______.____ f 7 , Width of Type of filter material ?_F(]_ r __—Depth of filter material_-." - ________-_dotal length______ _ _______ __ I. Seepage.Pit: Distance to nearest•wpll_____...____.___-----Distance from foundation:__________________ Distance to nearest lot line-_--_.--------- __ � ❑ Number of pits----------J_..._.--_-Lining material-----------------------Size: Diameter------------------,----Depth_..._..__...-----------._.------- Cesspool: Distance from nearest well__-'__:___::___Distance from foundation______________-----Lining material-------------- ❑ Size: Diameter-------------------------- Dept ---------------- ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----- -----------"--------------------------------Distance from nearest building---------------------------------_ -._. .. Distance to nearest lot line-------------------------------------------- - ------------------------------------------------"--------- c - -------.i- ---------_-_-------_--------. - Remodelin9 and/or repairing describe : O - --_- t`--------------- _______________._ -------�a_U_+ _____ ------- - -- - w -,--/ '--- ------ ------------ -------------------------------------------------- -- - -----------r-�---------------- ---- ------- ---- ig � - -� --"------------------------------- ----------------•----------------- - ----------------------------------------- ------------------------------------------------------------------- I hereby certify t atTl have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aw l and rules and regulations of_f6, San Joaquin Local Health District. (Signed] C r�:'�•---- ------- -� �' _' - f - e{Owand/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 .alc ------------------------ DATE------- REVIEWED BY --- I-------==------ -- -------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------: ----- DATE.----- ------------ � f • � �6 �,�C"--`--'-- --_ --c_.----�� r .` - _ . -- -- ------ - -------------- Aterations and/or recommendations•______________ -" -------- ---- �, ---------------------------------- -------= -��-5 -------------------- --------=-------- ----------------- -------------------------------- FINAL INSPECTION BY--------- -- - ------- ------------- --------------- ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT` , 1601 E.Ho:aifon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9Th Street t Stockton,California Lodi,California Manteca,California Tracy, California