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FOR OFFICE USE: Q -a - . ....................... .... .. " APPLICATION FOR SANITATION PERMIT Permit No. ........ ...............•........................... (Complete in Duplicafe( Date Issuedn/!f-tv7 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 compliance withTCounty Ordinance No. 549.. ;:Lq t q S • QA+*r.s� fi-esr c Gra d c/ �i JOB ADDRESS AND LOCATION12e....W.? /7d?!C,V'cwc,C n ,ray---. .h.--------•---- -------..."Y?.- ---•' ' Owner's Name... ................................._..- ............................_._..__......... Phona..& .............`.......... 6.. Address-I&OZ .. / ... ....--•---.._.......------...-----------•-------•---.._...._--------------------•-•------_..--------- Contractor's Name.... _t__4i....._re,V.�..s....6P.W..f't.x..t- 3 1c� Installation will serve: Residence ❑ Apartment House ❑ Commercial ©- Trailer Court ❑ Motel ❑ Other ❑—' (y, Number of living units: .-_..... Number of bedrooms-------- Number of baths ........ Lot size _._J_ Aa.r'rC........_..._................_..� ' Water Supply: Public system ❑ Community system ❑ Private [)t Depth to Water Table A.P. ft Character of soil to a depth of 3 feet: Sand 0' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date...................) No a New Construction: Yes ❑ No a FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest well_6Q_f....._Distance from foundation.../�_�.........Mataria).dcsP1C,r t'7-C,_--------------- [� No. of compartments......e�,.__.....-_._..Size_ ? !�p?l_��!_fw..liquid depth........��.__._.....Capacity...0_t.0�..._ Disposal Field: Distance from nearest well..........Distance from foundation..ke. .........Distance to nearest lot line..1_" .._-_. �- Number of lines.........An,...................Length of each line._...�ou_.............-Width of french.._E._`.._....._........__._... ' Type of filter material...A.gic.k.......Depth of filter material....1.1r!.........Total length....... Seepage Pit: Distance to nearest well-----_.__.._-.__.Distance from foundation........__...._.Distance to nearest lot line........._._.. 11 Number of pits.........---------__Lining material_.__._...-.__........Size: Diameter......._..._..........Depth..........._................._ ` ' Cesspool: Distance from nearest well.................Distance from foundation.---..--...-...-.Lining material_____.._..._._.._---._----- _... [� El Size: Diameter.........................- .................................................... -........Depth Liquid Capacity._. - -------------- ---gals. A Privy: Distance from nearest well........_..............-.......................Distance from nearest building............-........._......._..._.. ` ' ❑ Distance to nearest lot line.-------................ .................................•......................_.............................. - -----_-----_-_ Remodeling and/or repairing (describe):....7Xe.'.r...... .....W-L-I... _-...�t!��G,�•... ...,_.. ....sT-_ : yy !"m r- /G .• l�,Li' �%,tlw:!ss,.�,e_...----..,ffzzrsa>n-... .2'.r�f..?..�<:.7ya_...3'�. . --•••-•----- —..................------.........................•---•----...................................._.................._.............-.......................------------.- 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. % Q g� Ovr•.er {Signed}-•--•-• - •-�=--..6V�r...f.:` .,R.�.e---....----•---•---.._............................................_. _...---.................(Owner and/or Contractor) _s BY - -•--......-----_...----------------- ....._.. ------.......... ..........(Title)...........................................__.....__....... - (Plot plan, showing size of[of. location of system in relation to wells, buildings, etc., can be placed on reverse side). ARTMENT USE ONLY ---y� •---------------------- APPLICATION ACCEPTED BY.__-.-• - -.. ... . ., -......... ......................_._..._...---------.-.. DATE...,�.� - -- BY------ ........................ ....... .... .... .... ...............----------------_-------- REVIEWED --------- DATE-----------------_.....-------------............ BUILDINGPERMIT ISSUED._......... .... ._........._.... ......_..._....._...........................-- DATE ..........- - - - ' Altera+ions and/or recommendations:.........................................................---•••-------........------------_-----•--_-_-------- .......------- . --------.....................•.----_........---....................._..........._..._...__........................_...----...--•-----•—................••••-------------.........-_...-.-------------- - - — -- - ........................... - ..__................._......----...._......................................_. --..__..._...-------._.-----...----.......----------------..... ............. .. ........................._..._...................._............--................••-•--......................---•----.............•--- FINAL INSPECTION BY!,------- ,3—? 0..: .......................... .............. /JQ Date ...- SA IN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911,Street ' Stockton,California Lodi,California Manteca,California Tracy,California