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FOR OFFICE USE: ' -------------------'------I------------------ -------- APPLICATION - - APPLICATION FOR SANITATION PERMIT Permit No. ./.. ��- -------------------- --------- ------ ------------------ (Complete in Duplicate) Date Issued - ------------------------------------- _ ---------------- This Permit Expires 1 Year From Date Issued '__J3_. S Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. c7-ZS- rZS 6S .S- q A4,j 7-k E> " JOB ADDRESS AND LOC TIO __4 C44 KL0-------�--•-P-v' /-----5O ----------"C-ITI_`Ef_ f IC' ' � --------------------------- -------------- -------------------------- - Phone Owner's Name--------------------- �-- Address----------------��__- T- `i 1 g ---------- T _�_ (''------------------------------------------------------------.-------__ t Contractor's Name----CA-S ------5E l C----- ------------------ ---------- ------------------- Phone----------------------------------- - a W , Installation will serve: Residence E] Apartment House-,[] Commercial Trailer Court E] Motel ❑ Other ❑ oF Number of living units: _lumber of bedrooms _'-- Number of baths _r Lot size ____fRKA6_4EK---.---------____-________ Water Supply: Public system ❑ Community system ❑ Private 0" Depth to Water Table 1Z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date-----.---.----------} No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance from nearest weil__57 Distance from foundation----M-------_ Mater•al ------------- depth - _ lSQQNo. of compartments_______ ___._. :_Size_5X.1Q_X_5------Liquid ---------Capacity-- ------- -N V� •. Disposal Field: Distance from nearest well---5 ___Distance from foundation----I ---------Distance to nearest lot line--- Number of lines___.___��._____----------Length of each line_1_� - =- Z- -Width of trench______ __--------- . Type of filter material--_ROK_K---_Depth of filter material____. -----Total length_...__-__,-_-�25�__--___________ Seepage Pit: Distance fo nearest ______________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material't------.-_.-I------Size: Diameter-----------------------Depth--------------------------------- Cesspool: tance'fi}cm nea�e'sT'welf_"_>.' 4'Disi-ance from foundation---_...............Lining material__ Dis ___.....________________. ---------- ❑ Size: Diameter--------------------- --------------Depth---------------------i-- ---- ------_------------_Liquid Capacity------.------- ------------gals. , I Privy: Distance from nearest well-__._____________________ ___.____._--__._.----Distance from nearest building-------------------------------------__. -m ❑ Distance to nearest lot line - ------------------------- ---- --------------- -------------•-------------------------'e-'------ `-------------------------------- ~{ � r 4'` Remodeling and/or repairing (describe):-------------.---- ------------------------------------------- "- -------------------------------------------------------------------------•------------- ---------------------------------------------------------- ---- ----------•-------------------------------------------------------- --------•--------------------------•---------------------------- ---------- ----- I -- e- I hereby certify that I have prepared this application and that the work will be done in accordance with San 4g2 quin�County ordinances, State laws, and rules andregulations +he San Joaquin Lo�al Health District. - -�+-- f --- 1------------------------------- -------------------------------------------------(Owner and/or Contractor) (Signed)------ - -_---C.�. _�rtiKt�''�. By:------------------------------------------------------------------ ----- --- --------------- ---------- ------------------------(Title)---------- ----------- -------- -------- -- --- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------. '�J ----------------------------------------------------------------- DATE---------7.74- c�----------------------- REVIEWEDBY------------------------------------------------------ ------------------------------ ------------------ ---------------.--- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------- ------------------------- -------------------------------------------------------------- DATE------------------ ------------------------------------------ Alterations and/or recommendations:------- --777------ AnK-------N-07------ --5-------- =--------------------"----- "s,, -. -l E -------------------------------------------------------------- -- - ---------------------------- --------------•--------------------------•------------------------------------------------------------------------ ------------ ---- -- ----------------------------•--------------------------------------- -----------------------------------------------"---------------• ----------------------------------------------------- --------- --------------------------- - If 1/ 7 •------------- - - --------- ----------- -- ------- ----- ........... -------------------- Date---- --------- � FINAL INSPECTION �Q �f -S SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California