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,I E. _._. APPLICATION FOR -SANITATION PERMIT Permit No. .(�.�`__ ----------- --•--•--•-- ------- ------ (Complete 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. II r� JOB ADDRESS AND LOCATION y------------------•-•----•--• -----t---------- Owner's Name..................... ..... ..... 1AARP�2---- --......._ C --. CC ' -"� ------------------------------------- Address---------------------------- _ Contractor's Name----------- il.-------- - ---cmner)----- ------•-------------------------------------------------- ......................... Phone------__---------- Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_ Number of bedrooms A_ Number of baths ...I.-. Lot'size ..-----------49-4-A_....................-_.-_..--.._ T A/.tER faa h"NP�crtt'E Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table _ eft. Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam R"Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made,' (If yes,date................... ) No EY New Construction: Yes [kf o ❑ 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_4Q......Distance from foundation.....N_....... Matelal--_n�ECRS.�........................ No, oftcompartments_ ......-Q.. ..........Size...--�d_x-.p 0- YA .Liquid depth.... .'y.z Capacity_.1-�-c?'e.-. _.. Disposal Field: Distance from nearest well- _6.66-------Distance from foundation'-=f19----------Distance to nearest lot line...15......... Number of lines-__-_- ....19..................... �--...............-- Width of trench-------�----------------------- z - ---------------- Type of filter material'T __.Dopt� of filter material_.-.� ..____.....Total length------_.14 ?..................... Seepage Pit: Distance to nearest wellistance from foundation-------------------Distance to nearest lot line -- ❑ Number of pits......................Lining material..........-............Size: Diameter-------------------- Dept h.............•................... Cesspool: Distance from nearest well-----------------Distance from foundation--------_...........Lining material-----------------------------._--___- ❑ Size: Diameter_._:;. Dept h--------------------------------------- ------.- Liquid Capacity. ------_-_.---....._...gals. Privy: Distance from nearest well_.._-------------------------------------------Distance from nearest bu;ldin,g--_-._._...._.__....._...._._...""._._ ❑ Distance to nearest lot line............................................ •----------- ---------- ..................................................--- ---•---------- Remodeling and/or repairing (describe):----- --- --------------- - -------- .........._..------. -•---•..----------------...----......._...._..--.._..--------•--•-•--•------••-- n -------- ------------------------------------ ----•-• ............................ -------------------------------- .-..-----..----------•-------•--•--------•------•----•----._-_---------.--......-•----......••-•--..--•• -•••-----------------------------------------•------------•-•------------••••-•-•-------------•------------ ----------------- •-----------------•-•------------...•---•---•-------•----................................_... I hereby certify that 11have 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. (Signed)----! ['�``' ! vT}'-- /�� !'( - - - .{Owner and/or Contractor) By---------------------------------------------------------------------------------- ---------------------- _.. .(Title)... . -----.........-._ .................... .............. (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED .. ... ._.---•---------------------------•--•---------------•----------- ------- DATE-------- _3............................... REVIEWEDBY.... ----- -------• .......------------------------------------------------------------- DATE --- BUILDINGPERMIT I LIED ----------------------------------•-------..--_----.•_-------..... ---._........ ---------------- DATE............................. --•--•-------_.....--•--....... Alterations and/or r endations:................................................... ---................... -•--- ---•....._........ ------------------------------------................ ij f-------•-- --•• • ------•- ---------- -------- ........--------------------------------------------------------------------..- •-........................ .............................................A---••-----•--•-------•--•-----------------------------------•--- ------ ...................------..........------------...... ------------• Q---------------- ------ FINAL INSPECTION Date--..----_ . . .. `. /� �$ AN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave: 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfocklon, California II Lodi,California Manteca, California Tracy, California F :y —_ 4,. �i F.P.CC.