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FOR OFFICE U E: APPLICATION FOR SANITATION PERMIT Permit No. l '15 114........ �L l - -- �'� (Complete in buplicafel - Date Issued = =6' ---------------------:...... ,,- __.__.._.___ This Permit Ex fres 1 Year From Date Issued Go�-tdo•-t� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the won herein descn ed, This application is made in compliance with County Ordinance N . 549. /2;,t- 3 JOB ADDRESS AND—LOCATION- -----lz"A------ s3�� .... �� Owner's Name------ ----- --------------- - - ---- Phone----------------------------------- 2; •-------------•--••--------- - Address.-. .� I. - . ---_ --------- -- ---- f'� �.1 ------ � Contractor's Name - --- -- -- - - --- ------ ---------.-. Phone___V --- j(.K Installation will serve: Residence ;K Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelOther ❑ Number of living units: _�- Number of bedrooms __�. Number of baths __I--- Lot size --------- _ __ ___ _______ __ __________________ Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Table 45�Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Mader (If yes,date....................) No ❑ New Construction: Yes ❑ No� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S' is 5 Tank: Distance from nearest well________________Distance from foundation-------------------.Material-_____-______._-----._____________.------------ No. of compartments---- --------------------Size-----...-------•---------------Liquid depth-------------------------Capacity----------------------- ,j�am� Disposal Field: Distance from nearest well_-� _,�_-_- Dastance from foundation___3____._-------Distance to nearest lot line___ __�_------ Number of lines__________._____ Length of each line___. A-------fe-___ Width of trench_._. ` -R__________________ _ _ .. Type of filter material__5F_. _ Depth of filter material_._._�. ______._Total length--------------------3-�.. ------- --- r i Seepage Pit: Distance to nearest ell__ UD-.-_____Distanc om f ndation____�-Q.-------Dista Fie to nearest lot line_-.- /.,-_ -."`' Number of pits....__/-----------Lining material-__ ai� Depth_____..a-.��_-__.._ ..Size: Diameter____ _ ____________ ______ Cesspool: Distance from nearest well-----------------Distance rom foundation_._________.______.Lining material-_.._______-_.__________._________- Size: Diameter--------------------------------------De th----------------------------- ---- -----------------Liquid Capacity als. Privy: Distance from nearest well-------------------------------------------- _._Distance from nearest building------------------------------ -..-------- O ❑ Distance to nearest lot line----------------------------------------------- ----------------------- ------------------------------------------------------ ------------- �.� Remodeling and/or repairing (describe):------ ------- -- --------------- ----- -------------------------------------------- ---- -------------- ------------•-----•----=--•----•------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- ------------------------------------------------------•------------------------ ------------------------------------------------------------------------------------ -------------- ----------- ---------------- ----------------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to*Ws, d r les d regulations o the San Joaquin Local Health District.(Signed)-------------- -- -- -- ----- - ------------- -------------------------------(Owner and/or Contractor)_"Cy By:--- -------- -------------- --- Title "rr (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -- •---------------- DATE----------- / - - _._.__r_�.. -- --------------t... . .- -- -- ---------------- REVIEWEDBY---------------------------- -------------------------------- ---------------------------------------------- DATE----------------- ------------------------------------------ BUILDING PERMIT ISSUED ` - ;------------------ DATE-------------------c_ c {- .-- -------�'-- Alterations and/or recomptendations -_.-_ _. .__- -_-`,__j__ r_t___...__.______I^ ��___. _ ^~ L____� ._( f --�-------------- -- - ------� �- + ------- ---------------------------------------- -------------------------------------------------------------------------------------------------------------•----------------- ----•----------------------------------------------- ---•-•-• ------------ --- ---- ------ -- --------- - -------------------- - ------ - --------I- ------------------------------------------------------•-•------------------------------------------------------------------- r FINAL INSPECTION BY:--.......10 Q------------------------------------ Date------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.