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FOR OFFICE USE: , p----; - --------------------- �. -__________________ APPLICATION F0�2 SANITATION PERMIT Permit No. .... ------------- ----- - (Complete in Duplicate) 4 - ---- --------------� I This Permit Expires 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 herein degribed. This application is made in compliance with County Ordinance No. 549. ! ` �-1 G01 1"/Ulil JOB ADDRESS AND LO ATION.E7h_ ?rill,61 _/ .tGr_Q _ �1' `� �51?P...111f_ 'r_$1�G_ ,�1�`f-/� ' ti'lvW'" Owner's Name --------- --------- - -- -------------------------------------------- Phone...... •--------- --•---------._. AddressQd�, I hL�.�1�/ J�..� -------------------------------------------------------------------------------------------- Contractor's Name--------leor_ ----- '---------- --------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence 23,'-Apartment House ❑gg Commercial E] Trailer Court ❑ E]Motel ❑ Other Number of living units: __1___ Number of bedrooms�7---- Number of baths A--_ Lot size .`_�Ef'if%i'___________________ -------------- i Water Supply: Public system ❑ Community system ❑ Private [rbepth to Water Table 499Wt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�H-ardpan ❑ Previous Application Made: (If yes,date--------------------) No [G}/New Construction: Yes L&—No ❑ FHA/VA: Yes 5; --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: &-----Distances/from f!oundation-_--le.....-_-.Material---e,-- 0�/" ":,__..____..____--. No. of compartments---,?_______-______Sizej ,�p::Vy4,/tiquid depth----- ---------------Capacity//,rA0_------- Disposal Field: Distance from nearest well__11;1Q----._-Distance from foundation-----/4�7_----Distance to nearest lot line.- Number of lines------- Length of each line____ _____----------___Width of trench.it.______�_________.____..___,.�, Type of filter material/A——— .._Depth of filter material-___,�e6r___-Total length___ _:_____,-:-._�_r.__ 6 Seepage Pit: Distance to nearest well _,lj0!g*, _.__Distance from foundation___ ___ -_-..Disttaance to nearest lo,t�line__��______.. Number of pits---_-A---_-_____-Lining ma terial._�QG�__,Size: Diameter_x�s?_...___-_____Depth_s.20r,pp----------------_-_-.-_ Cesspool: Distance from nearest well --_--____.------Distance from foundation--------------------Lining mater ial_.__________________________________ ❑ Size: Diameter------------------------------------Depth-.----------------� -„ --------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well__________________ / ____._____.__________________Distance from nearest building______.__.___________._____._.._._.__. Rp ❑ Distance to nearest lot line------------------------------------------------------- ----- ---------`----=` 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 laws, and rules and regulati ns of the San Joaquin Local Health District. Si ned / - --- - r Contractor By:------------------------------------------------------------------------------- --- - - - ------------------(Ti+le)_ r//� ----------- --- ---- --------- (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR APARTMENT USE ONLY APPLICATION ACCEPTED ----- -------------------------------------------- DATE----- REVIEWEDBY---------------------------------------- ---------------------------------------------------------------------------------- DATE--------------------------------------------- BUILDING -------------------------------------BUILDING PERMIT ISSUED--- ------- ----------------- --------------------- - - --------- DATE Alterations and/,or recommendations:._ ----------- f -" --------`'C__��`------- _ ```, ------------------------------------------------------------------------------------��•��-- ---------- --------------------------------------=--- ------ ------------------- ----------------------------------------- ----------------------------------------------- -------- ------------- ------------ ---------------------------------------------------- ----------------- --------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:..-..--- fakStreet -1 ------ -. Date ---- ----- ----- ---------SANN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 We124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C O.