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FOR OFFICE USE: t - ----------------- ---------------------------------- --- ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..c . (Complete in Duplicate) Date Issued ----------_----------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby 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. M Dy P�if' Q_ -------- - �1 -------------- JOB ADDRESS DLO ATION ._____ -w_ -- Owner's m ___ ---- ---- --------•---------------- 1`' -�� 1'J-u .-- - ------ Phone Address-----•-----•--------------------• - ...------------------------------------------------------------------------------------------..-------•-------------------------- -- -- -------- ......... Contractors Name--------___ ------------------------33n Mod 1✓rPrt,P Ualte q Phone..-10 Installation will serve: Residence RT'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: ___j--- Number of bedrooms --- -- Number of baths ---t- Lot size -//_h_ __ ---------------------------------------- f Water Supply: Public system E] Community system El Private Depth to Water Table _k_ 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 Pl`�' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: �J�tie L I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__l0,)-_0.= Distance from foundation_-_ ® No. of compartments-.------_- ------- ---Size.---r'5 'k! - d-----•---Liquid depth._. -`------------Capacity.. ------ t' 1 Disposal Field: Distance from nearest well--ltID.....Distarice from foundation_-`D� _D----------Distance to nearest lot line__4_1-------- Number of lines________________/-----------------Length of each line------ of trench......,_q__ _.- ____-_._____--____ Type of filter material_ _: .....Depth of filter materiel----/�_.`..........Total length_.- -____________________. j C Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.__---_._-___-_ Q ❑ Number of pits----------------------Lining material--------------------=--Size: Diameter---:-------------- ---Depth--------------------------------- �})� Cesspool: Distance from nearest well'---------------Distance from foundation_.-_._..-_--___--.Lining material-----------.------------------------- Size: _-_._..____-__--__--.- Size: Diameter------------------------------ . Depth-------- _ 7w..- -��,.... F .r .-ru Ca Y ga s. - Distance from nearest building_._._ _--__.---------------------------- El _ Privy: Distance from nearest well ___�..__ ._.__. ________ .-- _ -- - -------- - ------ l ❑ Distance to nearest loft line----- ---------------- - --------------------------------------------------------------------------------- ------------------------------ Remodeling and/or repairing (describe):-------- --------------------- ------- ---------------------------------------------------•-----------------------•------------ --------•---- -- -----------------------------------•----------------------•-•------•----------•-------------------------------- ---------------------------------------------------------------------------------------------- J --------------- / 1 -------------------------------------------------------------------------------------------------- ---------------- -------------� 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) By:'{_ l- ------- --- -----(Title)-------------------------------------- -------------..... (Plot plan, showing size of to#, location of system in rela#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATIONACCEPTED BY ------ ----- ------------------- ------------- -------------------------------------------- DATE l--------7-------------------------- REVIEWEDBY------------------ -- -- ------ ------------------ ---------------...------------------------------------------------------- DATE----------------------------------- ------------ BUILDINGPERMIT ISSUE -- - -------------------•------------------------------------ _ DATE--------------------------------------- -------------------- Alterations and/or recommendations------------------- - - ----------------------------------------___-------------•----------------------------------------------- ----------I--------------- ------------------------------------------------- --------------- ---------------------------------------------------- ---- ------------------------------•-------------------------------•----------------------- -- --- ------------ -- ---------------- ------ ---- ---------- -- -------- vj A Date.__._._._ ' �! / 7-------------------- ---- ----- - -FINAL INSPECTION r` JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha: Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California t F.P.CC. t