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FOR OFFICE USE: it , ----------- - - --- -------------- ------------ -- .P-�.....--....-- I APPLICATION .1=0R SANITATION PERMIT Permit No. (Complete in Duplicate ----- Date Issued _ ii ,I This Permit Expires 1 Year From Date Issued --- iP 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. 3;o—[[) - - P 1 _ �: f� • -- `JOB ADDRESS AND LOCATIO :I_ �`--''-'�-- u ! ^ ' - s -' Phone Owner's Name_ ------- �c_ ------` _Address_. IVA Phone .. Contractor's Name--- - ---- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms __?_"'�Number of baths _J.__ Lot size ------ ------------------------- .a 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: .flf yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-rAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance frominearest well-_.__ O_"_.__Distance from foundation__.-!_P_-------.Material__._ --------------------- No. of compartments_------"? ----------5ize_ � pX__9.�X__SL/iquid depth____ ---------------Capacity. Dis os� Field: Distance from nearest �1....a��q_ Distance offrom each line foundation v_ ----------- r- -__Widthcofttrenchest�lo>< line____-------_k : pd� ,._Number of lines_ _________ ____ .... Length p- ------------Total length-------t 0---r------------------------ -,7 Type of filter material._-_-__S._�._______Depth of filter material i_ Seepage Pit: ,'Distance.to nearest well---_--_._____-____--Distance from foundation___________________.Distance to nearest lot line---- F . Number of pits--- ------------------Lining material---------- --- --- ----Size: Diameter--------- -------- ----Depth----- ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia------------------------------------- Size: Diameter------------------- ---Depth--------------------------------------------------- Liquid Capacity gals ❑ I . Distance fromt _ nearest well- _-_------------------------------------------Distance from nearest building------------------------------ ---------- .7" ❑ Distance,to nearest lot line----------------- ------------- ---------------------------------------------------.-. I Remodeling and/or repairing {describe):------------- -- ------------------------------------------------------ ---------------------------------------------------•---- ----- i ---------------------------------- hereby certify that I have re a ---------- -----�'--- ---- - ------ -- It----------------- - ----------------------------- - y y p p red this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules ,and regulations of the San Joaquin Local Health District. :, -------------- a or i (Signed)_____-__ a and/or Contr ct - ---- ---------------------- - -- r _ - - �Title�-`-----T--� �-`v----- ---..__'--"'-----`- rBY:--------------- ---------------------� v ------------- ---------------- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). M a FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY- ----------------------------------- DATE--- --------3 - _1''7------------ ----------------- - ---------- -- -- ----------------------------- REVIEWEDBY------------------------------- ---- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED---------I`---------- -------------------------- ---------------- DATE------------------------------ ------------------------------ f, ' Alterations and/or recommendations----------- ------------- -- --------- - -----------------------------------------------•-------------••--------•-------•------------------------------- ---•---------------------- --------------------- ------------------- - ' --- ---------- ---------- ---------- -------------- -------------- ------------- ------------------ ------------- ---- ------------------- -- --------------- ---------------------------------------- -- ----------- ------ 1 FINAL INSPECTION BY:_._.A -------------- �I SAN JOAQUIN LOCAL HEALTH DISTRICT + 1601 E.Hazelton Ave. ll 300 West Oak Street 124 Sycamore Street 205 West 9th Street. Stockton,California it Lodi,California Manteca,California Tracy,California is _