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FOR OFFICE USE: ------------- 1l .. ------------------------- ---- - ---- - Permit No. ..--- APPLICATION FOR SANITATION PERMIT ----------------------------- -------------- ----------- (Complete in Duplicate) Date Issued 3__=g 7 -------______---_____________ This Permit Expires i 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 maclein compliance with County Ordinance No. 549. f h .e JOB ADDRE AND LO CATION___ d> j� �- Phone------------------------------------ Owner s ame i'' �/�. ! - - ------ --------- -----• -------- - --------------- -- ---------- Address_- ' �._ 4 - ,�a= ------...4 4 , Contractor's Name----� _ __eo lw- -----------------• ---------------- ------ Phone.---------------------------------- Installation will serve: Residence JE�`'Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms a,?_. Number of baths 1Z.- Lot size -----------•--------• -------------� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -70 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 21 Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑. Hardpan ❑� Previous Application Made: (If yes,date___ -------_-------_) No 9 New Construction: Yes eNo ❑ FHA/VA: Yes ?�r— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we l__l.v� -_Distance f om foundation---Z.a-------- MatoriaL��4e,41p4__________________.I [ No. of compartments---- ----------------size -"-- -Liquid depth_../ __..--Capacity__F�v------- Disposal Field: Distance from nearest well.l-74,---Distance from foundation___��-__------Distance to nearest hot line,/h_._'-_ Length of each line--- e--F--------------Width of trench_s_�__-__-----.-_----------------E� Number of lines_______/-------------- g Type of filter material-/'Z.— eptf;,o`f filter material. -. --.Total length___ .-�______________________ Seepage Pit: Distance to nearest well---je ---___Distance from foundation_ e_�_-_.Distance to nearest lot line..�Q_� .Number of pits...._f -----_______Lining material_ � -.Size: Diameter__2,,1 f'�_._--__Depth_ „ � _ ___ f Cesspool: Distance from nearest well___.______._____Distncrom foundation___________________Lining material___.-_-..._.__..____.____--__.__.__. 171 Size: Diameter------------_ ------------------- Depth--------. .,_. ------ -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-- _---------?------------------------------•.._Distance from nearest building--.-----_--------------------------------. ❑ Distance to nearest lot line------------- --- ----------` --------------------- -------------------------------- - ----------- Remodeling and/or repairing (describe) = � i"r d- ------!C � , - ----- ) �,�-Z? � �7 ------------------ } - •---------`--- � - --------------- ----------- I hereby certify that'1;hwe prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Statelaws, end rules andR i egulations of the San Joaquin',Local Health District. _ r �- -_- Si ned �1 -`--.,, t✓- I Y - Contractor) 1 - '�.,. ', Title ¢ -------------------------------- By:_ (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). 8 FOR DEPARTMENT USE;ONLY APPLICATIONACCEPTED BY-------------- ---------------------- ----------- ----- --------- ----------------------------- DATE------- ��----------------------- REVIEWEDBY-------------------------------- -------------------- -------------------- -------------------------- ---------- DATE------- ---------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------- € f ---------------- ---------- DATE----------------------------------- Alterations and/or recommendations_______________________ r'' -------------------- I ,:_ ) --------------•-------------------------------------------------------------- i ----------- -------------------------------------------------------- ---------------- ---------------- ---------------------------------------------------- --------- -- ------------------------ -------------------- f f FINAL INSPECTION BY:..._-1...�-__. --------------- ---J-._ 1 Date------------ Y --------- -- -- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hozellon Ave. 300 West Oak Street 124 Sycamore Slreel 205 West 9th Street Stockton,California Lodi,California t S ?t y Manteca,California i "` Tracy,California F.F.0 O.