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FOR OFFICE USE: �--------- -- ----- rff-d4 v Permit No. ...11�ye_6 6----------- 's l/a APPLICATION° OF SANITATION PERMIT �-- f ---- --------- ------------ = 0 (Complete in'Duplicate)-- �s� __-----_-_--------------------_-_._--- --- This Permit Expires 1 Year From Date Issued 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 in compliance with County Ordinance No. S49. /,� JOB ADDRESS AND LOC TION....--- � - �A v`� fes---------- ----------------•---•----------------------- 6/" oma_- .-.- Owner's Name---------- •-• --- ----- %QTh�11 .� T�-- ------- �{ Phone_ . Address-----------------------------4_7 ----------I-----•---- +"'`�" zre Contractor's Name_________ 1.,�_ 1l Phone___!; P l Installation will serve: Residence [<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1__ Number of bedrooms _ -3 Number of baths __ Lot size .----------- -- 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: (If yes,date_-.............._-_) No C!r New,Construction: Yes ❑ No E SHA/VA: Yes ❑ No [�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public 'sewer is available within 200 feet.) 1. Septic Tank: Distance- from nearest well-_-.j:__------__Distance from foundation------------- Material_________________________________________________ ❑ No. of compartments------------- t----------Size--------------------------------Liquid depth------------ ------------Capacity-----------•----------• (� Disposal Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line_________--_-.-._ ❑ Number of lines-------------- ....................Length of each line--- -----------------------------Width of trench----------------------------------- Type of filter material___________ __________Depth of filter material------------------------Total length-__._________.--______._--_----______--._ Seepag it: Distance to nearest well/ r_-____Distance fr foundation__c' _._.___.Distance to nearest lot line._. s.____. _Linin material___ ' -...Size: Diameter____-3-a--------Depth____��' �------------- I � Number of pits----------1------ g �� Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material-_._..____._---__-_.._-__---__-__.___. ❑ 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):........ .r -,------ s I ------------------------------- ----------------------------'------------------ ------- ----------------------------------------------------------------------- --------------------- --- - ---------------------------------- ------- ------------------------------------------------------------------------------------•------------------------------------------------------------' I hereby certify th I have pr ws epared this application and that the work will be done in accordance with San Joaquin County ordinances, State laan rules and regulations of the San Joaquin Local Health District. Si ned C.1-' �� ----__t--- r or.Contrattor -------- ----------------------------------- Title .. { (Piot plan, showing size o lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side).' r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -----Z------------------------------------ DATE------ --- ��1--- --1'-------------------------- ------------ ---- REVIEWEDBY------------------------------------- ------------------------------------------------=--- DATE----------------------------------------------------------- BUI LDI NG PERMIT ISSUED------------- ------------ --•---------------------- ATE---- --- --------------------- Alterations and/or recommendations:--- ��/-� '� � � ' ,8 r --sa* �. , - ��__d �, ,per �.._ a_�� «�•-- ------' ------ y -- / .- `--a!/f� -------- a®®-� - Y ' .�T�LI�.ri� _: -* cam__ <• . ', __7` _ ,%rQ-- tss.,e --- W-i ------------ L---------------------------------------------------------------------------•------------------------------------------✓--------------- r �.��.--�-- ------- FINAL INSPECTION BY:- --- ------------------------------ - __ Date.------ `LOCAL HEALTH DISTRICT v 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California