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FOR OFFICE USE: /Q_-- - --------- ------ APPLICATION FO•R -SANITATION PERMIT Permit No.(Complete in 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 Ordinance No. 549. JOB ADDRESS AND LOCAT ON........Zl_7z�__._a?- � - / Owner's Name------------ /r 1, ---------------------------------------------------------- -------------- ---- --- Phone- -------------------------------- Address........... / Contractor's Name. .-/Y--/ ----------•------------------------------------------- ----------- ------••------------------- ---- Phone..--------------------------------- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms --A- Number of baths ._l___ Lot size ____ a..Q.../' �� ---------------_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 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 wi#hin.280 feet.) Septic Tank: Distance from nearest well--- o .-__Distance from foundation----�__0-------Material----- Q-i7 .- -- No. of compartments-_...__I>-------.-_Size--��,��}�.-la----Liquid depth_-------f_ e_.--_------Capacity---- ----- Disposal Field: Distance from nearest well_ Distance from foundation__/CG........Distance to nearest lot line___1:5__._s__._ q Number of lines_________z7, _ Length of each line___,90.r..........or Width of trench------- __ /�'f Depth of filter material...../ Total len l_�--Q-------_-- Type of filter material__. De_�rr�sp �__ .__._ length Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__._._.._______.. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------- Depth--.------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material____._.__-_______._-___._____-.__._. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------.Liquid Capacity- -------------------._._...gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building_____-__.._____..__--_____________-__. ❑ Distance to nearest lot kine-------------------------------- --- Remodeling -Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------------------•------------------- 3 __________________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I 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)------- --- ------------------------------- - - --------------------------------------------- -------------------------(Owner and/or Contractor) BYG+'�-+r !�'� ------- - ------- ---------- --------------------------------------------------------- ---(Title)---------- ------ ----------------------- (Plot plan, showing size of lot, locati system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----- --------------- ---------------------------------------- DATE-------/0_7547- ---------------------- REVIEWEDBY------------ ---------------------- --- -- ------------ ------------ ------------------------------------------- DATE BUILDINGPERMIT ISSUED----------_ - ------------------•--------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:------------------ ------------------- ----------------------------------------- -----------------------------•---------- ------------------ - ---------------- - •------------ ------ --------------------•-------------------------------------------- ----------------------------------------------------------------- -------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------- ---- --------- ------- -• - ------------------------ -------- ----------- ----•---------------------- ----------------------------------------------------- ------------ --- ----------------- FINAL INSPECTION BY:--- . - --------- ----------------- Date SOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.G a.