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APPLICATION FOR SANITATION K.AA1T Permit No. . ------------- .... ......... ___ (Complete in Duplicate) J` 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 c mpliance with County Ordinance No. 549. ESCq(.QN JOB ADDRESS AND LO ATION.aRNER ....14.W�-..-L0_. ....... ...5TEJ. YE U_L......................._-....... Owner's Name--- . -- ------- ._._ - - --------------------------------------- Phone...................... Address-----------H-1 .- -...3_..."._...Bv)<------23.1...--......-15sS.C:..:._....................................... --.-..........._............................. Contractor's Name-A1K-ANAE-D..--- .............._----- -..--------...---... Phone.------......----......------.... Installation will serve: Residence 99.E partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/.---- Number of bedrooms3--- Number of baths ../----- Lot size .IUUF�7� R -�...................... Water Supply: Public system El Community system El Private �apth to Wafer Table -�---A- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam lay ❑ Adobe C] Hardpan a' Previous Application Made: (if yes,date------- ._ ,�,an.__. ) No r� New Construction: Yes [R-5-o ❑ FHA/VA: Yes ❑ No R� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic Tsk: Distance from nearest well-.-�--.--Distance from foundation---t?Q..........Material...CQ./NORaE—C-T.l.............. [3� No. of compartments----- '1 ....._....Size..5..".p/A............Liquid depth......5..............Capacity./5MQ... �v Disposal Field: Distance from nearest well--J�O.....Distance from foundation...a?0.........Distance to nearest lot line.._,ty. Number of lines.-.----- —._...- . _-._Length of each line_J --d --�1 .---.-Width of trench----- �},_ e - - b Type of filter material--nVQ.CA.....Depth of filter material......��--.-------Total length...............�.--_.--.._....... to Seepage P't: Distance to nearest --- Distance from foundation...nl .--.. .......Distan a to nearest lot line.....t....---- I Number of ..-..--Lining matenaR.Q.G�i... Size: Diameter-'y-..S........Depth......1,P—_-I.....-----...... Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter -_......... . ......._.......Depth-_-.....------------------------------...Liquid Capacity............................gals 1;1f Privy: Distance from nearest well.-._._..........................._----- ......Distance from nearest building................................. . ._ ❑ Distance to nearest lot line.. --- --------------- -----------..._....- ........__....---_-_`-------------_----------------------------------------------.__. C Remodeling and/or repairing (describe):-............................................... ................................------`.........-.......` -- -..............................-. 4 -- - ----------- -------------- -------- -sy r��n------------ ...._.-----..............._- -. --- _...............................................................................---------------------- -. --------...-------....---............ - .............................. .......-- ----- ---------------------....................... --------------- ---.....------------. ...........-------------------------------------- - - 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. �1 _ (Signed).-.-'--- .-.. . � �!�. ( .'(:(, ...... ------- - (Owner and/or Contractor) 7 By:--------.............--......-------------... .---... ----...........-----.......----_----------------------(Title)................................................. .. .. ..... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). c� p FOR DEPARTMENT USE ONLY M / APPLICATION ACCEPTED BY .....1 ` �>-�� ' .............................. ................................. DATE ......?r-.-al�- .G. ....._.-....... REVIEWEDBY................. ........................---- ..--..--...-..._ _ .............. ...-...-...------- .................. ----- DATE............................. - BUILDINGPERMIT ISSUED.----- .......---_.. ----------- �^---^---------------------------- DATE-----------.....----------------------------•---- - - Alterations and/or recommendations:.. ........ .QTS_-...-- �....._,'5 .(vb_- ` ` - ` ..................................................... --- --- -- -. .............-• _............................_..--..--�.......�v ........... .......... .------ -----.---....... - ---....................................................................................................................................................... .................. - .. . - .. .... . ..... . ............. -.. .. .... ...... . ............................................................................................................... FINAL INSPECT Date....... d�.. .........._................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hacdfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California r.nco.