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FOR OFFICE USE: -.... . -- ............ APPLICATION FOR SANITATION PERMIT Permit No. . . ............ .................... (Complete in Duplicate) ,_//_c... This Permit Expires i Year From Date Issued Date Issued _..._.� ..c .. 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. �js'- a�^-O� SSC, JUB ADDRESS AND LO ATION_ l7. - _: fZG► 1. 0......---.1.(/.....OF------.X1tgt� ....1`V,_EA(-------�D_... Owner's Name /%dQ .L. _j R.1........---- . Phone---••-----••---------------------- Address----`---------------R 7��.-I px" 1 -`C O---------. SC/�LOIS/ ......... Contractor's Name------------ WN ER- ---------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial, railer Court p Motel ❑ Other aFREs7RooM Number of living units: __.----- Number of bedrooms ........ Number of baths .------- Lot size ---.-_.AGRt06�______� �..�.._ Water Sup{�ly: Public system ❑ Community system p Private �Depfh to Water Table �.. it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [h-'-Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................} No 5e---New Construction: Yes ❑ No �A/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: ';"(No septic tank or cesspool-permitted-if-,public-sewer is-available within-200-feet.)- 1 Septic T k: Distance from nearest well..'S�.___Distance from foundation...I __.....__Material--- ' No. of compartments........2_---_...---Size.-3_X..7 X._z> __,.__Liquid depth._ '/z.�_------Capacity__-�a_-----__ Disposal Field: Distance from nearest well._._,540-----Distance from foundation.... ._ ' p l _.._____Distance to nearest lot line_:_�_._.___... �r . Number of lines...--- -----/...... Length of each line---...... -.Width--._-_.Width of trench.......2 --__------------------ Type of filter material__-R.QC.K_Depth of filter material _^. �s ' -=--�-----Total length---�----------�•---------•-------------- �... Seepage Pit: Distance to nearest well....1067 -_-Distance from foundation..--1.--_........Pistance to nearest lot line.---:... 0� Number of pits...... ?Lining materialsSize: Diameter-. X.-- ..._-Depth........ld_'.............. . Cesspool: Distance from'ne,arest l------------------Distance from foundation....................Lining material.........---------------------------- S ❑ S'ze: D;a.nefer---- we, --- ---------_....---...--•• i--Depth----------------- ------------.---------------------Liquid Capacity------------.._._.._._._.._.gals. Privy: Distance from nearest well-------------------.------------------p---------Distance from nearest building.......................................... ❑ Distance to nearest lot line...:................:i=......................... - Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------- •---•---------------------------------•--------- _.................•-..--.. - ..........-------------------------------------------------------------•........._....................._............ ..._.................................. e -------•----- ----------•-----••----------•------•-•--••--......................----------------------------------------------------------------------------------••--•-----------------------------••--•-.-•----...------ 4 ------._--•..............................................-----------------------_-------------------------------------------------------- "------ .........._.._------- 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. p (Signed)---------lAz!L ------ - -------- -------------- - ---- ------------------------------------•------•--------......----(Owner and/or Contractor) . _ -------------------:. -----Tit e - __-----_-••:----�-•______ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----4T►.R_.O`........................... _----------------------------_.......... DATE..--------- REVIEWEDBY . ---.._............................_.............••.••---.--...........---••-••---------------------•---....------- DATE_------------------------•----•---....................... J� BUILDINGPERMIT ISSUED_.------ - ---------- -•••--....._......-•-- _----------....................................... DATE----_----------------- -- Alterations and/or recommendations:_.___................ t ................•. ------------------------------------------------------------------_--------------_-------------------------------------------------------------------------- --------------------------------- ......•--- •----•... ----......•.•••••..................--•--- ------- ..----.........---------------------•--------•-------••••------•-------------•--•----•--••••................._........... ..................-•-•--...•..--•---................... . ................ . - - ----------------------•--._-- .........._.__.._..__._._..........------•.---- •---•----••----._...--••-•-----........... ____________________________R.-___.----.._-_ _- --___..-..-....-.- -... _... _. -------._.__.__-___._---._--__-__.................................................................................. FINAL INSPECTIQL�Y- � � - Date... / 2 ..'��'7. _............... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California