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FOR OFFICE USE: ,� -------- 7-_ g---t'�-------------- APPLICATION FO ' SANITATION PERMIT� Permit No. ---------------------------- ------ ----------- ---- -- (Complete`in Duplicate) Date Issued _1j_I-__!�S_��-�•. ----------------------------------- -----------.._--_._._ 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 incompliance with County Ordinance No. 544. JOS ADDRESS AND LOCATION __ /-------- CvZ - -�-s------�N-� -------------------------- ------ �' ,� r -------------------• ----- ... 1 ------------------ ------- - - ------------------- Phone � `�x�: Owners Name.__.- _ - Address-------------113 ------— - ------- ----------- ----------------------•------•-- ------------=------._.... Contractor's Name------__------- �'P �`-----•------------ - Phone------------------ Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu! Q Other [� Number of living units: ___L_ Number of bedrooms____ Number of baths Z__ Lot size ____1- - -- -- - - ----------------- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table hi-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J6Hardpan ❑ Previous Application Made: (If yes,date............ .....__) No-V New Construction: Yes 0 No ❑ FHA/VA: Yes ❑ N/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I I Septic Tank: Distance from nearest well_SQ________Distant from foundati - Material. r ` L_______...._______. No. of compartments____________________Size--- _ __Y_ S-Y- 4 Liquid depth------?v-- ------------Capacity___ :n.._. Disposal Field: Distance from nearest well-S ------Distance from foundation----W-------._Distance to nearest lot line__ T'__________ Q r Number of lines________'___________ __ Length of each line__lGd1- --- -)----.-Width of trench-___- - ---- Type or filter material. _ _ ___Depth of filter material_...'_f. _ _______.Total length____° !G?______________________ Seepage Pit: Distance to nearest-well _______________------Distance from foundation------------- Dista nce.to'nearest lot line__.__.____.__..._ ❑ Number of pits----------------------Lining material-- -:---.-----------Size: Diameter-----------------------Depth-------------------------------__ I' Cesspool: Distance from nearest well-----------------Distance from foundation_:__.------------Lining material_-----__._.._____._____ Size: Diameter-------------------------------------Dept h_ .------------------------.------------------Liquid Capacity als.l i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.__._.___.__________________________-.._. ❑ Distance to nearest lot line------------------------- --- --------------- ----------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------- ------------- ----------------------•----•------------------- ------------- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- --------------------------------------------------------------=--------------------------------------------------------------------------------------------------:-------------------------------------- t 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. f (signed)-- -------------------------------T--- -------------- - / ----------- ---------------------------------------Title ------- ..-- - (Owner and/or Contractor) ; i By:__--------------------------------- ( ) '—� — (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 APPLECATION ACCEPTED BY- --- `i`� J - DATE. ?.Q� ------------- REVIEWEDBY------------------------------ --------- -- ------------------------------------------------------------------------------ DATE------------------.----------------------------------------- BUILDING •- •---•--•----BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE--------------------------- -------------------------•------ Alterations and/or recommendations:------- --------------------- - ---------------------•-----------------------------------------•------------------------------------------------------------- ai t -•----- ------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------ ------------------------------------J----- ---------- ---------------------------------- ------------------------------ ------------------------------------------------------------------------------••-----•••-------- ------ ---------------------------------------- -----•------------------------------------------- ----------- ------------ -- ----------------------------- -------°-------------------------------------------- ------------------------------------------- --------------------- ----------------------------------- ------------ ------------------------- ------------------•-------------------------------- -------- - . ----------------------- FINAL INSPECTION --------------- Date------ ------ ------ ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street `t Stockton,California Lodi,California Manteca,California Tracy, California F.P.CC. .. 1 CU