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/ FOR OFFICE USE: ---------------------------------------- ---- ------ -- ---------- ----- VarPLICATION FOR SANITATION PLAIT Permit No. 7� " ------- ------ -" •" " (Complete in Duplicate( -- - -----------PP------------- --- ---- - .--- This Permit Expires 1 Year From Date Issued If—,. Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work}��y(� I�+�Wr This application is I mpli mice o ty Ordinance No. 549. S/ 1 A AI/U JOB ADDRESS AND LO ATION- for ® -------------------------------- Ph - Owner's Name-- _----_ ® �� ' one.......... - .... --------------- Address.............l?'a.-={y�,// Contractor's Name_." - - - -------------------------------- Phone------ ---- -- Installation will serve: Residence ❑ Apartment House E] Commercial Commercial Trailer Court ❑ Motel ❑ Other Number of living units: ------- Number of bedrooms --- ---- Number of baths -------- Lot size --- --------------------- ----------- Wafer Supply: Public system ❑ Community system ❑ Private Q] Depth to Water Table 1�?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (jf Clay Loam ❑ Clay ❑ 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 foundation_Iq- ._".._. Material- ------------- ------------ Z.,No. of compartments_.S-c.--.-.__..----.-.Size:-.a_*--?t---6.__--Liquid depth__cr...____.....-Capacity�Q-U._-------- Disposal Field: Distance from nearest well- SW---------Distance from foundation_A-1-----._-.Distance to nearest lot lineX,f-.--... w ® Number of lines----._ _--_.._.._..-.Length of each line------I-Ro--------------Width of trench..y,`I-',""-----._. - 9 Type of filter material.K-<.- -------- ..Depth of filter materiaL../?.`-----------Total length.,/ .--._..-_--.---------__ W Seepage Pit: Distance to nearest well --------- -----------Distance from foundation....................Distance to nearest lot line------------..-_ ❑ Number of pits---------------------Lining material---- ---- _.---------Size: Diameter--..--------- --- ----Dept h_-----------------------------_ .� ---..------""_ _ --------- ___ -Distance from foundation....--""------- .. Lining material - - -. _ _.__---.- .- Cesspool: Distance from nearest well . ❑ Size: Diameter-----------------— .. ...Depth--------- - ------------------------------. Liquid Capacity------------------------gals. Privy: Distance from nearest well----------.---------------------------------__Distance from nearest building--"------------------___-__ ❑ Distance to nearest lot line------- ------'----------------------------..-------------------------------------------------------------------------._..__. 'O Remodeling and/or repairing (describe( ------------------------------- . ------------ -----------'-----------------------------------.........::.----------- ----------------- ------------------------------------------ --------------------- ----------------------------`-- - - -'------------------------------------------ --...--------------.-.....----`------------- -------------------------------------------------------------------------------------- ----- ------------------------------. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State, and rules and regulations oft San Joaquin Local Health District. (Signed)'-.1'`-��. '- - - --. --f-�-F'ti, _-.....- -_.---- - ------ --- ------(Owner and/or Contractor) By:-------------- OK -------------I---------------------------------- - ------------------------------(Tine)-------- . -- (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---- - - - ------ ----------------- DATE--] -----/1.-4`---------------------------- REVIEWEDBY------- -- ------------------------------- -----------------------------I--------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------- ------------- . Alterations and/or recommendations:------- ----------....-.----------------------------------------------------------------------------------------- - - - -- - --- - --------------------- - ------ ----------------------------- --------------------------------- .... ------------------------- i FINAL INSPECTION BY:./0 -- - __ Da+e -A- L 6 - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 705 West 9th Street Stockton, California Lodi, California Manteca, California Tracy,California r.P co.