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FOR OFFICE USE: -------------------- ------------------------------------ ..---�___.___._.._._-________. APPLICATION FOR SANITATION PERMIT Permit No. ______ __________ ------- .lP ..-- . ---- ---------------;;---------------------------- -- (Complete in Duplicate) Date Issued h Date issued 5--=17- -__..---.-- _ - --------------------:___..__ This Permit Expires 1 Year From �"v Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION...--- 686 Furth ---------------- ---••-.- _-L Owner's Name--------------- �° ` .�''> e" C., ', ------------------------------------------- ------------------------------------------.-- Phone-------- Address----- ------ Address----- -----------128VorthEberhardtRoad 1-nd __ . - . - `• I `" � . Contractor's Name--•---- Ct® +� �7 _ + ' ._.�° Yll IL Cit" * D '--------------------------------------------------- Phone------4.83!!!3.4.1------ Installation will serve: Residence ESC Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---0 Number of bedrooms -..2-- Number of baths ----X_ Lot size ......IQ_-fit r—e-;n-----------------------._ Water Supply: Public system ❑ Community system ❑ Private ❑X 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 ❑ New Construction: Yes [:[ No ❑ FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS:- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___.1QQ1_Distance from foundation----10-1------Material__---_Conn 'e-to------------------- EX No. of compartments ------- - -- Size----____-------_-_-.---------__Liquid dePth _-----___ -------------Capacity----5QQ--- o1e Disposal Field: Distance from nearest well-----15.01-Distance from foundation--------------------Distance to nearest lot line----2.Qt_---- EX Number of lines-----------1--- - --------- Length of each line--- 0 ---------_----..Width of trench-.-.----.-�_......._------_---- Type of filter material-- X-__Vtepth of filter material-----------------------Total length------1.QQ- Seepage Pit: Distance to nearest well_._�Mt--------Distance from foundation-------------------.Distance to nearest lot line----10!---- EX !Number of pits------9-------------Lining mat erial__QAbh!!kASize: Diameter---- -- ----------Depth...... ------------------- Cesspool:- Distance from nearest well-----------------Distance from foundation-- -----------------Lining material--------.------------_ -------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: uF Distance from nearest well-------------------------------------------------Distance from nearest building----- _-.-------------. . ------- 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, State laws, and rules and regulations of the San.Joaquin Local Health District. (Signed � ------------------- --------Owner and/or Contractor By -- ..... -- - ---------------------------------------------------(Title)----r e 14o nt--------------- . .. - (Plot plan, s owing size o lot, lova ton of system 'n relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------------------------------------------------ DATE------ --------------- REVIEWEDBY---------------------------------------------1b------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE---------------------------- .............. Alterations and/or recommendations--------------- ------------------------------------------•--------------------------------------------------•---•------------------------<--- ---------------- -------------------------------------------------------------------------- -----------------•----------------------------------------------------------- --------••---------------------------------------- ---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------•- FINAL INSPECTION BY:.__ �- ---------------------- Date---- ¢eW�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD. f