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FOROFFICE USE. =' f --------------- ---------------------- ------ _ ________ _____ ---------- -------. APPLICATION FOR SANITATION PERMIT Permit No. ,a—,/ .7. {Complete in Duplicate) ------------- 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. 549. JOB ADDRESS AND LOCA710N_2r`�`d -� G/� t O I�( Owner's Name-- _. f/ !J° ------------ Phone_7-Z� Address2 i...H o A -- ------ -- --�----N------------ ---j---_--------------------------•-----------------------------.---------------------------- Contractor's Name----- ..... I Installation will serve: Residence (K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other F1 Number of living units: I------ Number of bedrooms 3_.-. Number of baths -2-- - Lot size ____1 C .EA. ------------- Water Supply: Public system ❑ Community system ❑ Private.[�r Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand (j Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date__---__--_-_____-_1 No 2"� New Construction: Yes ❑ NoFHA/VA: Yes ❑ No TYPE OF"INSTALI:ATI' N-AND SPECIFI(:ATIONS-�"12` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) rol « Septic Tank: Distance from nearest well--.-,I __Distance from foundation-------_Q-------Material------ t_`<a_f_-------------_____-`_-. 597 No. of compartments--------------------------Size--------------------------------Liquid dept----------- - ----- _ Capacity_- .;, � _ --fT Disposal Field: Distance from nearest�well_...tJ" ....Distance from foundation----1.4-------Distance to nearest lot`idle----S___-.----- Number of lines.--------- -------------- Length o�yeaclne------- ©-----------Width of trench.------ --------------- Type - ---- -----_Type of filter material---126'-Cek....Depth of filter material-.-_-j_��._---------- length _70-------- Seepage/Pit: Distance to nearest well....Zt:)__._......Distance from foundation-_--I0-----.. ��,,//�?istanc to nearest lot line----------------- l� Number of pits--------/------------Lining material-_-{6G-K---___-Size: Diamefer.Y..__x--- ----------Depth--------1. ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--__----- -----------------------:-__. n Size: Diameter---- --------------------------------Depth---------------------------- ---=---------Liquid Capacity.---------------------------gals. Privy: Distance from nearest well .........................................Distance from nearest building---_-..--_.-_.._-_--.-----.-.----..-.__.. ❑ Distance fo nearest lot line......................... Remodeling and/or repairing (describe):-.---------------------------------------------------------------------------------------------- I -------------------------------------------------------------------------------•---------------------------•------------------------------------------------------------ ---------------------------------------------------- ------------------------------- -------------------------------------------------------- ----- -------------------------------- --------- ---------- -------------------- 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)----. C`--- - '-- --------- --.- ----------------- -- ----------(Owner and/or Contractor) j i. � --..•� _,..-.. �,. ted.,- - .� _ _�.. - �Y=----------------- ---------------------------------- --- ------------------ -------- ------------------ ----- -----(Title)--------- ---- --- ------ ........ -- �+ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` l APPLICATION ACCEPTED BY---- - -j- c.R-=Q------ ------ DATE----------/'2 6, ....----------------- REVIEWED BY------ ------------------------ -------- DATE--------------- ------- ---- -- -- - --------------------------------------------------------------------------- - ------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------- -------—-------- ----------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-- - - ---- ------------------------------------------------------------------------------------------------------------------------ -•------------ ------------------- -------------- -------------------------------.------------------------------------------------------- -•------------------------------------------------I-------------------------- 0 ---------------------=------------ ---- --- -- - ----- ---- ------ ------ ------ -- ---------------------------- -------------------------------------------------------- ---------- -------------------------- 1 1 ---------------------- ----- _ :.. - FINAL INSPEC ION BY..� . : jam. ---- --- 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 7iacy,California