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FOR OFFICE USE: -68' ------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete-in Duplicate) Date Issued .��:.� ----- -----_ This Permit Ex fires 1 Year From Date Issued�4 Application is hereby made to the San Joaquin Local Health District for a permit to constr c# and i II the work herein described. ,This ap lication is made.in compliance with County Ordi nce No. 549. 13-!70 JO ADDRESS AND LOCATION '" . -- --l-�tJ ,y AA tt q --,S --------------------- -------------- ------- - Phone�t _7- /�®� Owner's Name------�-`��- -°--------- -'- - l � �_ An Address-------------------------- // ------ r Contractor's Name ---------- e-- -- ---------- - ------- ----------------2�� Phone. ��lf�� Installation will serve: Residence D, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: _t--___ Number of bedrooms Number of baths_1_____ Lot size ---(tea--K-_-f-s0-fl-- ------------------------ Water Supply: Public system d Community system I] Private $ Depth to Water Table eft Character of soil to a depth of 3 feet- SandGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------._---- _- ) No New Construction: Yes ❑ No XFHA/VA: Yes ❑ 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 well-----------------Distance from foundation---------------------Material __.____-___----__-_-_._____-_______-___-_----_- ❑&SW06 No. of compartments------------------------Size--------------------- ----------Liquid depoth---- ---- --- .......-Capacity---------------------- Disposal Field: Distance from near st well- f__-Distance from foundation_- _0�_..Distance to nearest lot line_._l�1_-�` �C Number of lines.___ 1_)-- - -__ ___ Length of each line_- -� _:- Width of trench-___ -"_______________ ri ---.:-- --a Type of filter material_-- _ _------.._-._ ._Depth of filter material___--_ - --------Total length_______7_S__--.------------------- Seepage Pit: Distance to nearest well------_---------------Distance from foundation--------------------Distance to nearest lot line----------.______ ❑ Number of pits--- ------------------Lining material--------------------- Size: Diameter-----------------------Depth--------------------------------- t Cesspool: Distance from nearest well ----------------Distance from foundation----------------- -.Lining material------------------------------------- IJ Size: Diameter- -- --------- ----- -------- ------Depth----- ------------------`------------- Liquid Capacity-------------r---------- 9 tPrivy: Distance from nearest well-------------------------------------------------Distance from nearest building_.---------------------------.---------_J .M ❑ Distance to nearest lot line ` ---------- p --------------I Remodeling and/or repairing (describer---- ---------------------------------------------------------- ---------------•- ------ - --------- L r ----------•---------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------- --------------------------- G I hereby certify that I hav re ared this application and that the work will-be done in accordance with San Joaquin County ordinances, State laws, and r es a d regulations f the San Joaquin cal Health District. - - ------ ----------------- -- -- ------ -- ----- Owner and/or Contractor ► -----Title (Piot plan, showing size o ot, location of system in relation t wells, buildings, etc., can be placeon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = - ----------- --------- -------------- DATE- Z---- --------- ---- REVIEWEDBY---------------------------------------- ---------- -------------- -------------------------------------- ---- DATE------------------------------------- --------------------- BUILDINGPERMIT ISSUED-------- -- --------------------------------------------- --------- -------------------- ---------- DATE----- ------------------------------------------------------ Alterationsand/or recommendations:------- ------------- - ------ -- ------------ --- f-------I-----------------------------•---- ----------------------------- ---------------------------- --••---------------- ----- --------- --------------------------- -------------------------------- - -- ------------ ------- ----- ---------------- --------------- ------------------------------- - FINAL INSPECTION BY:_. .................... ------------------------ Date.---- -- _ - �_ 4t------------------------------ 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 E.H.92M 1-67 Vanguard Press