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FOR OFFICE USE: _- - �- �., i ----------- - --- -------------------------------- APPLICATION -----------= -- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- - (Complete in Duplicate) A ' Date Issued __. This Permit Expires 1 Year From Date Issued _ �ed 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;,com liance with County Ordinance No. 549. t , -OT 770 (AM..�_JP_G. -.. -R JOB ADDRESS AND -0,7; ,7710 iT .Ra 7 - Phone..._.. - Owner's Name tHl L ._)._ ��31�_ = © '--- ----- --- --- --- ------- 6.32 ...H_A}AnIu R--------LN-=---...._.1.�A.T F-�: .4 '--.._.�.. -- ---- --Address-I..........__ . . • --- -- .. ------------------------- Contractor's Name------- -FL7 L- ----------------------------------------------------------------------------------------------------•--.._- Phone----------------------------------- Installation will serve: Residence 0- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms __3__ Number of baths i__._ Lot size ----V4Y-----x__3.3---• ------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _--- ft. Character of soil-f; a depth of 3 feet: Sand E] Gravel E] Sandy Loam� Clay Loam E] Clay ❑ Adobe I-] HardpanF]Previous Application Made'. (If yes,date-- ------------) No New Construction: Yes ��lo E] FHA/VA: Yes No [:1TYPE OF, INSTALLATION AND SPECIFICATIONS: o septic_ _tank or cesspool permitted-if;pub7ic sewer=is.available within 200-f eet:)' '� i"• � � _ Septic `n k: Qistance from nearest well--�&W,__Disfan from foundation___f�_.____.- Material----<0.NCI3F__T1� --_. i t No. of compartments..___ -------------Size__YX1�__K!.___Liquid depth----- / .....Capacity-. � ._. Disposal Field: Distance from nearest well..C•. C D`Di Lance'from foundation--------------------Distance to nearest lot line--------_-_____. _ ft2�_ a'- .-.Width of trench--------- I Number of lines________ _.___ -_-_---.-______Length of each line_ _ ..___. _ _ ' f Type of filter material___ .Q _.____Depth of filter material---I "._.______Total length _ _ ___._�9 ___-__--_______-- \' Seepageld Distance to nearest well______________________Distance,from foundation-------------------- Distance to nearest lot line._---____.-.._. \\'! ❑ W Number of pits----------------------Lining material--- -------------------Size: Diameter----------------- -----Depth_...__.__..________________-.. -- v Cesspool Distance from nearest-well-----------------Distance from foundation--------------------Lining material_._..._..._._______..______._.____.._. ❑ Size: Diameter------------------------------.--.--.Depth----I!-------------- -------#----------Liquid Capacity gals. Privy: Distance from nearest well--------------- .__'"--------i-------_ ---- _Dis'tance from nearest building--------------------------------------- Distance to nearestlot .-. 1 ❑ line-- ------------ ---- -----•-------------------+----`f-------------------=----------- ------------- -----------.------------------ -------- -- - , Remodeling "and/or repairing (describe)_------------------_------------y---------- '! fn lI IF, I $ 2 1 + k I hereby certify that 1 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. (Signed) `-- � -5 y� - ' (Owner and/or Contractorl (Plot plan, showing size of lot, location of system in relation to bwells, 61uildin4ii, `ef�c., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY_____ _ �_ a _ _ t i -- -- -- -------------------- ------------------ ------------------------ DATE------'%!-`f'-�----��'.�_------------------------- REVIEWED --- -- - REVIEWEDBY------ ------------------ - ----------- - - -- --------- -------------------------------------------------------- DATE-------- ------- ------------------------------------ BUILDING PERMIT ISSUED----------------- ------------------------------------------------- ---------------`""'-- DA•TE------------------------------------------------------------- Alterations and/or recommendations----------- ---------------- -------------------------------•----------•---•---=-----------------•----------------------------------------------------------- # t I == _ -----------------------------------------------------------•------ ----------------- ::__��.: _ _ 4 ______________________________________ _ _ ___ _ _ _.__ - _ -_--- _-__________---------------------------______.__ w�o..r..r FINAL 'INSPE CTEON BY: Dates-- 2 -- -- ---- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RC O. _