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FOR OFFICE USE: - -----------------=------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ----------------- - ------------------ (Complete in Duplicate) Date issued _6." _.InA—' _-- ------------- --- This Permit Expires 1-Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the herein described. This application is made in compliance with County Ordinance No. 549. E 7-Y00 �. JOS ADDRESS AND LOCATION---j-.-.-/-----------1- Owner's Name--- --- �4.-.1rr_�� - - -------------- Phone-J��'V—��57 Owner's --../. Box----:- -----------A�-qz-�7- ---0-----------------------•--------------------------------- Contractor's Name--- Z:/4/' J /, !` ---- - N-S- _N_----------- Phone..- _ .Q _ Installation will serve: Residence A ar+ f bedrooms Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: ___j_._ Number o _,3'__ Number of baths __? Lot size ------- ---•----------- Water Supply: Public system ❑ Community system ❑ Private LD^epth to Water Table AkO'_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay N Adobe ❑ Hardpan [M A3 Previous Application Made: s(lf yes,dote____________________) No a New Construction: Yes E],,o ®. FHA/VA: Yes E] No � W TYPE OF INSTALLATION AND SPECIFICATIONS:` (No septic tank or cesspjo perfnitted-if'public sewer is available within 200 feet.) _-r--- Septic Tank: Distance from nearest well________________Distance from foundation__._.__-________.__.Material______._---------------------------------------- . ❑ No. of compartments- ------------------------Size_ •-------------------------Liquid ----------- Capacity-----------------------ell) Disposal Field: Distance from nearest well--_,50____.Distance from foundation-___l0_-._.__.Distance to nearest lot line--- 1i Number of lines------ ------------Length of each line-----• "�-------- Widthof trench----- -.g------------------ Type of filter materriial l_____A�� Depth of filter material____ _��.._.Total length---------§Q---____________________ . Seepage Pit: Distance to nearest well.. ._`__--Distance fro foundation__-/�__►___.Di�+stance to nearest lot line__"3_ .._ Number ofits'_._ �.-Lining material__ aG.t'_.Size: Diameter__-___ _ Depth------vS________________ Cesspool: Distance fiom nearest welL__I _Distance from foundation-_----------. .....Lining ,material---------------_.__.________-_____. ❑ Size: Diameter--------------------- -----Depth----------------------- Liquid Capacity gals. ----------- Privy: Distance fiom nearest wel!____._.________{..___A______................€}isiance from nearest building------------------------------ __...____. ❑ Distance to nearest lot line------ ---- -- --------------------- ---------------------------------------------------------------------------------------------- ' Remodeling and/or repaEr;ng describe :____- C ------- V------•----------------------------------------------------------------------------------------- ------------------------ •--------------•------------------------------------------------------- ------------------------------ ----- ------------------------------------ ----------- ------------------------- ------------- ------------------------------------------------ -------------------------------------------------------------------------------•------------------- I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, State la rules and regulations of the an,Joaquin Local Health District. } !� � ,f�._. i✓ ----------------- ------ -- ner d/or Contractor} (Signed}.. J - r--- BY:--_-------- --- ---- -----------_- - ------ --- --- ---------------------- ------------------------------ ------------ (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY_ -------------------------------------- DATE. '`31__" -- ---.-------- REVIEWEDBY-------------'------------- --------- ---------------- ------------------ ----- -------------------------------------- DATE-------------- -' -------------------- BUILDINGPERMIT ISSUED----------------- ------------------------------------ ----------------------------------------------- DATE--------------------- -------------------------------------- Alterations and/or-recommendations-----------.----------------- ----- `--------- 11 ---------- ----------------------------------------------- ------- - ------ ---------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------- _•-- -----•------------------------ ------------------- --------------------------------------------- --------------•---------------------------------------------------------LJ FINAL INSPECTION BY:.. �vl_ - - --------- Date-IS7-31-�bl�...... - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.