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I -- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. s .•___.____.., ----------- --------------------------------------------- Permit (Complete in Duplicate) ----._-- m it Expires 1 Year From Date Issued Rafe Issued This P 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 w th Countyy Ordinance No. 549. �J-�Ji 0 2-2_030 -02- JOB ADDRESS OAD LOCON_I-. -- ---- - ----�a3 9 �, ---Owner's Name �-^----- ---- ---------- -- Phone. - Address-----..�� .. .�?pp� r�,7 ---------------I�J-----------------------------------------------------------------------------------------••----•--------------------------------- Contractor's Name�.t1!T __ _ �_ S + _ Phone______________________________ Installation will serve: Residence Apartment; House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t--- Number of bedrooms __c2_ Number of baths t------- Lot size __�p_�-3_�_�K--------------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __f__.pft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe ,��/Hardpan 4 P ❑ �� ❑ Y ❑ Y ❑ Y ❑ L7 ❑ Previous Application Made: (If yes,date_____________j_..__-] No Er New Construction: Yesg-l<o ❑ FHA/VA: Yes ❑ No [j4— TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_:�r_147---------Distance from foundation~__�--------Material .__ Materil-_a ---------------------------------------------- No. _________D___. __ ____ __ No. of compartments__ ____ ___________Size___._3- _J/------- Liquid depth __ �._ `_____. _..Capacity<e�u Disposal Field: Distance from nearest well_.3�'49__--..._Distance from foundation__/P------------Distance to nearest lot line.___-____i W Type of filter materia___ ____....__Depth of filter maferia4_4______..___.Total length----- ---------" ------------------ ------------ - Number of lines------------/---------I-----------Length of each line---_�_O Width of trench_-d,�___ I Seepage Pit: Distance to nearest welled_`___-________Distanrom foundation__/_ _'__.___.Distance to nearest lot line-------------- _.33 ... [Ly Number of pits_..._._______________Lining materia___ .a4_' ------- Diameter__. .. .Depth.._.Ir �•�_�__________------ Cesspool: Distance from nearest well---- Distance from foundation_-------------------Lining material----.---------------._-_-__-_________El 1 Sizer Diameter ;` ----Depth------------------------------------------------Liquid Capacity---- -----------------gals. Priv Distance from nearest well_____________________ _ ______________________Di0ante from nearest building-------------------------------_ ❑ Distance to nearest lot line---=---------------- ; ------ ----------------------- -----------------------------•---------------------- Remodeling and/or repairing (describe:- - 7� = - ---------- - -------• -----•-•----• --------- ` -----•------•---•------•------•--------- ----------•----------•---------------------,------- ---------------_--------------------•------------------------ ------------------- ------------ ------------------------- ............ ------------------------ -•--•----------------•----------------------- -------------•----•---------------------------•----••------------•------------------- ------ ----•-------------------------------- e. ----------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------- 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, a rules and re la 'ons, of the San Joaquin Local Health District. ------------ ---------- (Signed) -------- --- '' ----- -- ---------------------------Owner and/or Contractor { / I ---(Title , I By: - - - { ) ----------- (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., can be placed on reverse side). ,t a ' FOR DEPARTMENT USE ONLY l' IF APPLICATION! ACCEPTED BY--------- ------------- --- ------------------ DATE------------/- '.------------------- ----------------------------------------- REVIEWED BY---------------------------------------------------------- - DATE- ------------•------••----•----------•-----•-•-•--•------- I BUILDING PERMIT ISSUED................. .....•------------' - - . DATE r Alterations and/or recommendations----------------------'......................... ---------••--------------------•--------------•--------------------- ------------•---------------------------- -------------------•---------------------------------------------------------------I--------------------------------- ------------------------------------------------ •---------•-------------- --------------------------- ------------------------------------------------------------------------------- -------------------------- ---- ----------------------------------------------------------------------- ------------------------------------------•---------------------------- ---------- •-----------------------=-------------------- ---------- -- •---------------------•-- -- ------ ----- - ------- ----- ---------------------- ------------- ------------------------- ----------------- ---......-•- --------•-------------------------------------------------- -- -- ---- FINAL INSPECTION BY:-------- i Date. l//G --- ------------------ -------------- SAN J#AQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lode,California Manteca,California Tracy,California F.F.CO. �^