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F SE: �15. . . ...... -r " _ APPLICATION FOR SANITATION PERMIT Permit No. .-..._......o.._ --------------------------------------------------------- (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 coristruc an instal t e_,yvork herein described. This application is made in compliance with County Ordinance No. 549. / JOB ADDRESS AND LO AT ON 8SOO-�, 0 r� rfi2n'1 rr�r��r�rt �tl � �-�� 'I, Owner's Name 11 d - L--�C---G ------------------------- ---- Pho(ae__ `� j l t---------------T ---------- -- �6` M ---------tom e9--'�- ----------- Address- •-••---- A-- -- ----------------- fi'� L 1� T Gf� -o / 1(o -IF Contractor's Name--------•-•------------------`-----•DL[�f-'-u------��----- `-• - ------------------------------------ Installation --•----------------------- -- Phone.._/ �_a - Installation will serve: Residence 9, Apartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms __-�►�_ Number of baths __1771ot •----------- Water Supply: Public system ❑ Community system ❑ Private jj� Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ;Clay Loarri;&ClaYZ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction`: Yes No ❑ FHA/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-__4�___�.-----Distance from fouxxd-ation__.__j�--"____..Material_____________________._________ No. of compartments-----------2-----------Size-----��X-A-------Liquid depth--------_V_._--..-_-Capacity------1000. Disposal Field: Distance from nearest well._._,6.d-_--Distance from foundation------j-__.---Distance to nearest lot line---- Number of lines-----------,5----------------- Length of each line---------J`- 0----------.Widfih of trench--------- `` /--- Type of filter material___:5�_! i:_Depth of filter material_ 2�7______Total length---____________��_�""_________. . Seepage Pit: Distance to nearest well_----___--------------Distance from foundation--------------------Distance to nearest lot line_____..___.._____ G� ' ❑ Number of pits----------------------Lining material--------.--------------Size: Diameter------=----------------Depth--------------------------------- C) Cesspool: Distance from nearest well--------------_-Distance from foundation....................Lining material---------.__-._---_____.._.___-. �*I1 ❑ Size: Diameter------------------------- -------- ---Depth------------------------. --------- _==---------Liquid Capacity- ------------------------g; Privy: Distance from nearest well ------------------_"_.__--_._-___._-1_--_ Distance from nearest buiAing--------------------------------- # ❑ Distance to nearest lot line------------------------ ------------ ------ -----"---------------- ------------------------------------------------------- Remodeling and/or rep irin.9 (describe)------- ~� } ""� `��C'� ---------=j -�-------`-r--c ----------------C-------------------- --- C _ � - _ - ------ - --- ` ----- = - -1� ------ ------- ------- _ _ _ _____ _________________________________________________________________________________________________________________________________________________________________ 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. (Owner and/or Contractor) (Signed) ------------- - - ----------------------------------------- ----------- ----------------- ��.- '--------------- ----- ----, �`!` 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 APPLICATION ACCEPTED BY-------- ---- -------------=----`�A`: ` =-------- DATE------ --- ;7; -- REVIEWEDBY------------------------------------------ ----------------- ---------- - ------- DATE----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------ ------------------------ Alterationsand/or recommendations:---------_----- ----- --- --------------------------------------------------------------------------"•---------------------------- ------------------- --- --------- ------------------------------ FINAL INSPECTION BY------- - ..._ Date"- / iSf---------------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Ha:eitan Ave. 3001 West Oak Street A24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I F.P.C t]. v