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FOR OFFICE USE: c� APPLICATION FOR SANITATION PERMIT Permit No. .,1..1_. ....13... -- --d--------- (Complete in Duplicate) ��Afl�S� l Date Issued .__._ _____ t` ----------------------_ - + - . - 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------?kS` _L----------- r IoQc's ~--------- Owner's Name--- t' .`-�. ----------- ._�._I_�_.e r-------------------------------------------- ---------------------------------------- Phone_._�J t----r---OS fj Address-------------------- ? 1v � te�� 1Contractor's Name----- - --------- _v - ` . Z Installation will serve: Residence Pd Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms 3---- Number of baths __L3_ Lot size --------(-------- --------------------- Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table _--_oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r.Sf Hardpan ❑ Previous Application Made: (If yes,date------ -------------) No New Construction: Yes ❑ No K FHA/VA: Yes ❑ NoX 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-----------------Distance from foundation--------------------Material:: _.--_-____-.-__.-__-_-__--_-____-_--.-_-___--- ❑ aid- No. of compartments-------------------------Size-------•----------------•------Liquid depth--------------------------Capacity-•-•----•----- ----•- Disposal Field, Distance from nearest well__).'___Distance from foundation____-_P_'.-------Distance to nearest lot line-----0:_...... Number of lines--------------)---------.----------Length of each line----------s��S=_�-_.-------Width of trench----------er;! -._--.--._--- 6- Type of filter material--- c�cTl�_-Depth of filter material----.-__1-�1.._......Total length------------------------------------------ Seepage _--_ _..___-_--__-----S-___-.___-.--Seepage Pit: Distance to nearest well-----)_P.........Distance from foundation----s.3-P?'___...Distance to nearest lot line----4��.___._ S Number of pits----------I__.------Lining material S s-_+ G-) .Size: Diameter--------&&.......Depth----.------- -_._--_--- Cesspool:` � `i Distance from nearest well-----------------Distance from foundation--------------------Lining material_--- ------------------------------ Size: Diameter------ -------------------------------Depth------------------------------- ----------------_.-Li.-Liquid Capacity-----------•--------------. ❑ q p Y gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest building 0 Y g A ❑ Distance to nearest lot line--------------------------------- ---------------------------------------------------------------------------------------------- - -----� ts5 h' -- e--`=�------------------------- ------------------ Remodeling and/or repairing (describe):._-__�.�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. (Signed)----- ----------------------------------------- = ---- --- ---------- -------- -- -----(Owner and/or Contractor) BY: l ------------ -- -----------------------------------------------------(Title)------ -- ------------I------- -- - ------------- (Plot plan, showing sizei of lot, location o sys+em in reation to wells, buildings, etc., can be pieced on reverse side). FOR DEPARTM T USE ONLY?. APPLICATION ACCEPTED BY... '- -------- ---------- DATE_._.---- - -- ___-- REVIEWED BY------------------------------- --- ------ _---- DATE BUILDING PERMIT ISSUED_ j ------------------- --. . DATE. Alterations and/or recommendations: --- �ur��f- !' s -..._. 7,I�. --- - ----------------------------------------------- ----------------- ------------- ------------- --------------- x ,�;---------------- ,l �9ys r'� �`� -----------•--•----------------------- ---•-------------•---------•------- ------- i ---------------------------------------------- -------------------------------------------------- ---------- -------- ------- -------- ------------------------------------- -------------------------------- ------------------- ---------•-------------------------------------------- ---------- ----------------------------•-------•--------------- ------------ -----•-------------- -------------------- ------- ------------------------------------•------------ ---------- i x FINAL INSPECTION BY:-'-- ��----------- -------------------------- Da e-------- oxeooms ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.