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FOR OFFICE USE: ----- APPLICATION FOR SANITATION PERMIT Permit No. --------------------- ................. _. � �_.... ------------------- -------- --------------------------- (Complete in Duplicate) 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 compliance with County Ordi ante No. 549. nA JOB ADDRESS AND LOCA ION---••--- '�5 - --- Q��PH---------Rt>----------------------1----1'�'Ga�---------- -- OwnerOwner's Name -- Phone------------------------------------ 's QST --------------------- -------------------- ---- Address_ -----•---- s n_f- .......-.R.---------------M-rte ------------------------------------------------------------------------------ Contractor's Name-------.........O-L,-V-.a-E=--. ----•--------------------------------------------------- ------------------------------------- Phone----------------------------------- Installation will serve: Residence El—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '61Number of living units: _-I-_._ Number of bedro`oms __Z_ Number of baths _/__ Lot size ____4�_�? ------ Number Water Supply: Public system ❑ Community taystem El Private [Depth to Water Table . _ ft. Character of soil to a depth of 3 feet: Sand'�Gravel ❑ Sandy Loam e Clay Loam ❑ C ay El Adobe [-IHardpan [] Previous Application Made: (If yes,date--- ... 1 No New Construction: Yes No ❑ PHA/VA: Yes ❑ N0.O-_ 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__ _p____Distance frooundation-----IO-------M,at1er�a�------- 1DD_=.... [rr No. of compartments------- _i ----_--Size---- �X�.___Liquid depth__._.jam.-___Capacity____ _..___ Disposal Field: Distance from nearest well- I __-_Distance from foundation ---------Distance to nearest lot'line.� . Number of lines__________ ___f q1 Length------------- of each line---------- ---- -----/�-----Width of trench---------_��__6_.F_______._-- Type of filter material- Q_C_K__Depth of filter material_____1 ______--Total length---------------- -b-_---_-__--___--.- Seepage Pit: Distance to nearest well_ ._ ---.Distance from foundation------------------- Distance to nearest lot-line--.-------- ji� F1Number of pits----------------- --Lining material----------..----- -----Size: Diameter--------------- Depfn-------------------------------- W Cesspool: Distance from nearest well_#---------------Distance from foundation-------------......Lining material___----____-----_-_----.---------.--. Size: Diameter----------------- -- --------------De th------------------------- _ ----------Liquid Capacify gals. Privy: Distance from nearest we ___________ ______________________________Distance from nearest building------.----------------------------------- [ Distance to nearest lot line - - -------------------------------------------------------------------------------------------------------------------- ---------------- \A Remodeling and/or repairing (describe):------ -------------------------- ------------------------------------------ ---------------------------------------------------------I - ------------------------------------------------------------ ------ ,- - ----------------------------------------------------------------------------------- ------------------------------------------------ i , ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ L� I Hereby certify that I have prepared this applicefiorl and that the work will be done in accordance with San Joaquin County ordinances, Statej/�1pws, and rules and regulations of,the SanlJcaquin Local Health District. {Signed (s/f('J ((�i�' '«"3 1- V 3 ------------- ----{Owner and/or Contractor) ---------------------- —_ -------------------Title - - . ------v.u_ (Plot plan, showing size of lot, location of.systern jn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY q I LIF APPLICATION ACCEPTED BY---------__R- Q-------- ---------------------------------------------------------- DATE.-----------72/ --- -- -----`-------------- REVIEWEDBY--------------------------------------------------------------------------- ------ DATE------- -------- ------------------------------------- ----- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- -- DATE----------------------------- ----------- ------------------- Alterationsand/or recommendations---------------------------------------------- - -------------------------------•------------------------------------------------------------------------------- ------------- ---------- '�_ .- ------- '------------------------------------------------------------------------------------------------------------------------ ---------- ----�2----,/ ----- Ay- ----- s'TB-fi '1 =------- ` R-©r------------- ------------------------------------------------------- - ------------------------------------------------------------------- ---------------------------- --- ---------------------------------------------------------------------------------------------------------------------- FINAL INSPECTI - 1 . Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California V- Manteca, California Tracy,California Sti F.P.Cp. iwr