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FOR OFFICE USE: -------------------------------------- ___________ ___ _ _ _ _ APPLICATION FOR SANITATION ERM ED Permit No. ....__._____ .--._.._ ------------------------v\ (Complete in Duplicate) 9 This Permit Ex- ires 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 he inibed. This application is made in compliance with County Ordiijahce No. 549. JOB ADDRESS A LOCATION. �A-d-u. ` �z------`--.....- ----.Rd--- ----------Q----------- --C - Owner's Na ------- ............................. Address_____ t ---------------------- Contractor's Name r�'�Z• ----------- - ---------------- Phone----•---•-••-----------------------�/ Installation will serve: Residence ❑ Apartment House ❑ (Commercial ❑ Trailer Court ❑ Motel ❑ Other X Number of living units—. - __ Number of bedrooms l.--_ Number of baths /----- Lot size_____ _ _______ ______ ____ ------------------ Water Supply: Public system ❑ Community system ❑ Private [epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam❑ I Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: (If yes,date____________________) No E] New Construction: Yes ❑ No E] FHA/VA: Yes E] No El-- --. ^►•--.�-...moi--�....,._-��-�......-�._ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well---v'�a_�---Distance from foundation_____.»_�___.I`1 aterial___-_ __.. __ Na. of compartments_________.-O_!__Size_ -'4'-'X---9'-.! Liquid_ d�epjh !- .-____________Capacity__� 00 Disposa ield: Distance from nearest well----- ._..._Distance from foundation___.__<____- ____.Distance to nearest lot lines_.____..____ Number of lines___._-____j...___ ______ _Length of each line____1� ..�_____---.Width of trench----2 __ __-__________ ----------- Type of filter material.__.._-__tiZZ---------Depth of filter material __:�`�-...._ .___Totaf length_,eD_[•-'___________________________ Seepage Pit: Distance to nearest well------------ ______Distance from foundation----___------- ____.Distance to nearest lot line.._____._________ -L ElNumber of pits----------------------Lining material-----------------------Size: Diameter.-..- !----------------Depth---------.---------------.------- V,Cesspool: SDistance from nearest well-----------------Distance from foundation------------------'L'•inirig material----------------------------------___ ❑ ISize: Diameter-.----------------------------- Depth-------------------------------------------- t`!,L quid Capacity_-------------------------gals . I Privy: Oisfance from nearest well--------------------_---------------- ..----Distance from nearest building--------------------.--------------------- ❑ � n Distance to nearest lot line:.- ->__ _ _________________ ) 4 g =------------------------------------------------------------- Remodeling and repairing [describe]: .-_ ' 9 .-------------------------- _- - ------- ------------------------------------------- D' ------------------------- - - - - ------ ---------- --- 711- ----- �?' -=='�------------------- ---------- -----------"----- ; 'I I hereby certify that I have prepared this application and that the:w.orl w.iIU.e done in accordance with San Joaquin County G ordinances, State laws, an r les and regulations of the San Joaquin Local Health Districf.,T- ..h _ . .�. , ( g )_= _ _= ----------------------------- --------------------f'---- -------- By: and%o�-Coritractor), BY = - - ---------------- -------------------------- -------------------(Title)-----------------------------------------.._....-------..-------- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). t t FOR DEPARTMENT USE ONLY t/ APPLICATION ACCEPTED BY___. ------------------------------------------------ DATE--- --------------- REVIEWEDBY------------------------------------------ - -------------------- -------- --- -------- -------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------ --------------------------------------------------------- - DATE---------------------------------------- ---------- Alterations and/or recommendations:-------------------- ------------------------------------••-------------------------------I--••---------------------------------------------------------------- i I I ----------------------- ---------------------------------------------------------------------------- ---------- --------------------------------- -- ----------------------- ---------------------- I ------------------ ---- --- --------- ------- ---- ---------------------------------•--------------------------------------------------------------- --_.-.... ----------------------- -------- 1 FINAL INSPECTION BY4� ---------------- --- Date- ----- ' SAN JOAQUIN LOCAL HEALTH DISTRICT " A 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California