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rvR vrri�_c uot: w A- ., -------------------------------------------------- ---- v� APPLICATION FOR SANITATION PERMIT Permit No. •�-Qo�L (Complete in Duplicate) --- -- ----------- ----------------------------- - ---- This Permit Expires i Year From Date Issued bate Issued Application is hereby made to the San Joaquin Local Health District for a permit o construct and install the work herein described. This application is made in compliance with County Or ante No. 549. �� Q JOB ADDRESS AND LOCATION_ ��---- / - /1! Owner's Name------ l ,l/ �? ��1�® /�� .0----------------------- -------------- --- Phone__ Address--------------------- � " Contractor's Name.----- Phone-- ___-- -- Installation will serve: Residence [K Apartment House ❑ Commercial ❑ Trailer Gourt Motel ❑ Other El Number of living units: ___/__ Number of bedrooms -3Number of bath _ � __ U '' s . s _ o La t.sae -O-X/. ---------------- Water Supply:PP Y Publicsystem ❑ Community system..❑ Private ® Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy�,Loam E] Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (I€yes,date-------___-".--"""--I NoJ� ' New, Construction: Yes E3 No ❑ FHA/VA: Yes ❑ No at TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted,if.public sewer.is available within 200 feet. Septic Tank: Distance from nearest wel Distancefundaion___/O _ Maters�____9/j7 ,5�" No. of compartments__.____. ..__ ize_� _ ��''_ Ld depth__A. ~.Capacity_/ tea" Disposal Field: Distance from nearest well__ �.._ _Distance from foundation___ ----_-----Distance to nearest lot line------------ ------- __�____ Number of lines___.__________ ° 0- q Length of each €ine_ :� `_ __7,�VWidth of trench..__. Type of filter material"�'�Q� Deptn o€ filter material___,l9_`° Total length__p_'-t�C?"_'--"-"-_' ---------- , ._. Y ,_ �....� .. Y Seepage Pit: Distance to nearest well________�_ -_-------Distance from foundation_-_.-_:____-______.Distance to nearest lot line-_____4---------- ❑ Number of pits-------I--------------Lining material--- --- ----------- Size: Diameter-----------------------.Depth--------- ------------ --- Cesspool: Distance from near st well_________________Distance from foundation_._._________.._.__Lining material--------------------------------------- El Y Size: [diameter------- ----------------- -----__Depth pLiquibd Cdapacity - _-• ��.-...�--=,ria: __�� _ -__�� Priv -aresf w i€ � i;-; �...� +.� �, a.. -� ..R.d _._ -� --,� y: Distance from nearest well__ :'___ --------------------------------------Distance from nearest ui in t * t I 9 ------------------------------------- ; ❑ Distance to nearestlot line._:----------------------- -----------------------------" Remodeling and/or repairing (describe):-- �( -___- �r�� r -------- ------------ ----- •---------------- -----------------•-- - - - , -- ----------------------------------------•------------------------ ----------------- ------------------------------------------------i 1 ------------ ----------------- --------- - = = ' = t_ =-- -- -------------------------------------------- ---=------- I hereby certify that I have preps ed this ap`plication�and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations.;cf.the-San Joa°p _ ocal Health District. I 1 r (Signed---------- ..: r_._/7C ,.. �+ `F r. F { S----- &----------- and/or Contractor] By=------ ---- ------- --- ---- -- ------ ------------------ --- ----I------ -------------- --(Title) _ - ...... ...:... ..... [Plot plan, showing size of lot, Ioca ' n of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- __________ DATE__-----------------------------------------------I ------------------------ ------------------------------- REVIEWED BY----------------------------------- -- - - ------- - --------- DATE-----------�------------- - ------------ ----------------- I---------- - BUILDING PERMIT ISSUED I ------------ ----------------------------------- DATE.---------- t ._ T Alfieratioris and/or'recommendafions:_______________: �....- - - - ---- :___„- _`-_----------------------------------------- ------------•--------------------------------- ----------------------------------------------- t e- ---------------- ` ------------ ------- - -------------- ---------------------- ------------------------- ------------- - ---------------------------- =�-. - `� = - ----- ------------ ---------------------------------------------------------------------- FINAL INSPECTION BY:._.___.______--"-"-- r --- --- ---------------------- 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 Manteca,California Tracy,California i