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FOR OFFICE USE: ------------------------ - t'T'� ------ r _ _ APPLICATION FOR SANITATION PERMIT Permit No. --------------- ------- ,o -- - 1r� (Complete in Duplicate) Date Issued - ------------------------------------ ----- --- 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 work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- air !-- . ---�t9al -------------------------------------------------- Owner's Name a /J -- Phone'L�G,3_-___�/ePss' Address_�s:�i_' . _ 4,4t--- _ ..____. ____. Contractor's Name_____ _ __ ______ _________ _________ __ ---- t�Pho�e. l .—.3iyz- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Motel ❑ Other ❑ Number of living units: l Number of bedrooms __,l_ Number of baths ---?. Lot size --------___.---___.--__-. Water Supply: Public system ❑ Community system ❑ Privatele ' Depth to Water Table _ aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ Previous Application Made: (If yes,date________________) No [R'New Construction: Yes P-INo ❑ 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_ S__/..__f—__.Distance from foundation-J0.s_.___-__.Material___ _______ I_______________________ ❑� No. of compartments______. __.._.t Size---3XS ---Liquid Capacity-_9 Disposal Field: Distance from nearest well-52 ---------Distance from foundation.,?.Q-,►......Distance to nearest lot line------s�- [�� Number of lines----------f----___ -- Length of each line.._glJ__--__-_��__--...Width of trench__..P _'y__----_____________ __ Type of filter material_J� ------ :5RQ-----------------.___-___-_- f ,0Seepage Pit: Distance to nearest well_�!¢Q____.__....Distance from fo dation_�Q4_�_._..Distance to nearest lot lineS.�_ v [ Number of pits-----/-------------Lining material__ o _p- -Size: Diameter__ ',�._1_..---.___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--------------------------------------------------------------_---- Remodeling and/or repairing (describe: 4i '�" .�-yQyJ<' ------`-••-- -•--•-----•------. --------- ------ ----� '--�--�1 -------------------------------------------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San J aquin Local Health District. � 1 (Signed)----------21--- -- - "'t'' '.'�L .- (Owner and/or Contractor) -------------- (Plot plan, showing size of lot, location of system in +o wells, buildings, etc., can be ple- elationn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ '- _. ,__._`j DATE____��-_ .�-_�_.J._...__.____._____..._. REVIEWEDBY---------------------------- ---------------- -------------- -------------------------- DATE--------------- --------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.----- -------------------------------------------------- .. Alterationsand/or recommendations------------------ ------------------------------ ------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ---------------------------------------- --------------------I---------------------------.-...---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------ --------------------------------------------------------------------------------------------------- FINAL INSPECTION BY.-,/ Date Date - ---------------------------- SAN JOAQUIN L CAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.