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FOR OFFICE USE:-------_I /'O------ --------------- ----- -------- -------------------- APPLICATION FOR SANITATION PERMIT Permif No. ......... --- ---- -- ----- ----------------------------------------- (Complete in Duplicate), Date Issued -------------------------- ---------- This Permit Expires 1 Year From Date Issued Application is hereby-7madeto the San I Joaquin 'Local'-Health bls�fricffor a`p"er'imlif to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549. JOB ADDRESS A , 1D LOCATION ------------- ---G-0 -------- Phone-----—------ Owner's Na�ne- - 0 - - - - --- ----— --------------------- -------- --7-- --- I -------------------- --------------------- Address-----•-•--•- ..... ----------- ....li2a --- ---- ----------------•--------------------•------------ -.% --------------- --- ----------------- Phone---------------------------------- Contrador's. Name------ ------- A Installation will serve: Residence ZApartment House ❑ Commercial E] Trailer Court [:] Motel E] Other ❑ Number of living units: .!._._ Number of bed ?"', t k rooms-,)�--- Number o -aths -------- Lot size _____-_6, 40�- -- ---------- Water Supply: Public syste'm ❑ Community system El Pr Number to Water Table --- ft. [] Character of soil to a depth of j feet: Sand ❑ Gra4 [].❑ Sandy Loam Lj Clay I Clay E] Adobe Ej Hardpan E] Previous Application Made (If yes,date--------------------) No El New Construction. Yes D No 0 FHA/VA: Yes Ej No E] TYPE OF INSTALLATION"'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distancl from nearest well-------------_----Distance from foundation--------------------Material------------------------------------------------- ❑ No. of 'compartments-------------------- ----Size--------------------------------Liquid depth-------------------------.Capacity----------------------- 2111�1Dispos ield: Disfanclel from nearest well- Distance from"foundation...---/Cr_ Distance to nearest lot line--.5--------- Number' of lines----------- Length of each line_-_-_-1049 1-049-- --------- Width of trench--.._ ------------------ Type of, filter material.-W -------'Depth of filter material------Z 00,..-.--_.Total length--------/4!-4)------------------------ Seepage Pit: Distance to nearest well- - ------------------Distance from foundation------------------- Distance to nearest lot line----------------- Number of pits----------------------Lining material-----------------------Size: Diameter----------------.--__-Depth- -------------------------- Cesspool.: Distance from nearest well-----------------Distance from foundation------------- ------Lining material--------------------------------------- Size: Diameter---------------------- --------------- Depth---------------------------------------------- -----Liquid Capacity-. .------------------------gals. Privy: Distance from nearest well------------------- ----------------- ----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------------- - F �f„ Remodeling ine---------------Remodeling and/or repairing (describe):---------- ------ -- ---- ---------------------------------------------------------w----------- -------------------------------------- ------------------------------I-----------------------Z----------------------------------- ---m-- ------------------------------------------------------------------------------------------------------- ---------------------------------------I-----------------------:--------I------------------- ----------I---------------------------------------------------------------------------------------------------------------- 44. *-4-4.4 -.ml 1 0 ---------------- ------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I-hereby certify that I have prepared fW-ipptic-a,tion and.fhat the work will be done in,accordance with San Joaquin County -e ordinances. State law ! rules and regulations-ofrfhe San Joaquin Local Health District. d or Contractor) t., (Signed)--------- ----- ---- ------ ------------------- -- -----�i- I............ ---- ----------------------------- ----- ------------------------------- E -1,o buildings,By=-------"--.. - ------ ----------------------f........V-1---- ------------------ ----------------------(Tif le)-----------------------------------------------------I----------I-,/- (Plot plan, showing size of 10't, location of system in relation rto w Ifs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED; -------------------------------------------------------- DATE---/�?---/Y -1/024" ---- - ------------------------ REVIEWED BY------- !I - ---------------------------------------------------------- ----------------------------------------------------- DATE BUILDING PERMIT ISSUED�----------------------------------------------:----------------------------------- ----------------- DATE Alterations and/or recommendafions:------------------------------------- - ---- - -------------------- ------------- iF ---------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ----------------------=-------------- ---------- --------------------------------------------------------------------------- ------------------:----------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------I --------------------------------------- ------ ------------------------------- -------------------------------------------------------------------------------------- ----------------- t 11 1 ----------------- ----------------------------7-------------------------------------------------------------- •----------------------------------------------------------------------------------- --------------------------- FINAL INSPECTION BY: ---------------- D a t"e------- --------------- .... ... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxellon Ave.,:j 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California Ky 9 RCV19CD 13-59 3M 3-63 F.P.00.