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FOR OFFICE USE: 3 _A_y----------------------------- ------ -------------------- -- _ __ ___ _ _____---]- j--- APPLICATION FOR SANITATION PERMIT Permit No. •- _-_.-_ ---{ , ---- (Complete in Duplicate) / D - Date Issued __-_ :�.� _...----------------------------- --------- This Permit Expires i 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__._,-V)---------- '=-----AH_7. P5----------------------------------------------------------------------------------------- Owner's Name----------0.4,/ 77/5 5.....---�-,W/.7--------------- ------- ��.... . ---------- -------------------------------------------- Phone---------- ------ Address------------------------65/- t --`------------------------------------------------------------------------------- ---------------------------------•--------------..................... Contractor's Name------------ ti2T/�/_ _I------! 4 -----------T ./ .. S.lr 6------�/ -2 •--------------------------- Phone-- - . Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/--- Number of bedrooms ' ... Number of baths -_-4 Lot size ------1 '4` _________________ Water Supply: Public system� Community system ❑ Private E] Depth to Water Table _-g- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date----.---- --------._) Noj 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: a Distance from nearest well_________________Distance from foundation-------------.------Material------------------------------------------- .____. ❑ C-$A5 " No. of compartments- ------Size--------------------------------Liquid depth-------------------------Capacity-•-------•----•------ Disposal Field: ( Distance from nearest well-_ -47N Distance from foundation._..,r.� --. `_- Distance to nearest lot line...:.�:_.�_.... >`l<�S'�� Number of lines--------------Z------------------Length of each line-----------2 1---------Width of french-----------.?-fi�------__-----_ APO Type of filter materi1aal-_,3. 6-,-/C Depth of filter material_ le-"' Total length-------------------------��----- p _- Seepage Pit: Distance to nearest well f11 :_..._Distance from 'foundation--------- Distance to nearest lot line--.'----_-__-__ LA AMP Number of pits----------/.. Lining mate ria l___��C----Size: Diameter------.��t�.`+_. _--Depth---------i -$--.____-__-.--_ ^\ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 1:1 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):-------ff/1`2--.----�` -------FX/:F 1/>�-�-- 5, T "------------------------------ ----------Xs:e....... ----- i • ------------------ ----------- I I hereby certify that I have prepared this application and tlat the work will be dgne in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin-C:oU aHealth D14rict. (Signed) ------ .' - (Owner and/or Contractor) ------------------------------(Title)_ By:------ -- ----------- - ( ) --------------------------- - - (Plot plan, showing size of lot, location of sys+e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- = --------------- ---------------------------------`-------------------- DATE-----------:-V 4---------------------- REVIEWEDBY----------} - ---_--._---------------- -------------------- ------------------------------•----------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------e--- -------------- DATE--------------------------------------- ------------------- Alterations and/or recomm d ion ----------- ----__-._ -._---_-__.--_---._----_ ----------- .-------- ------ .- - -- Z��__-4------------------ - .. ------------ ------------------------------------------------------------------------------ -------------------------------- --- ---------------------------------------------- ---------------------------- ---------------------------•--------------------------------------------------------------------- ----------------- --------------------------------------- ------------ -------------- ---------- -----------------.----------- --------------------- ----------------------------------------- ---------- ------ FINAL- INSPECTION BY-------------- '_-- ---------- E Date-------- ----------------------_ ----------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.