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FOR OFFICE USE: 3 H A q/Y -------- -------- APPLICATION r R SANITATION PERMIT Permit No. --/............. -------------------------------- ------- -- ---- ------ (Complete in Duplicate) -------------------------- - ---- -__ ___ _-___-____ This Permit Expires 1 Year From Date Issued Date Issued ------- Application is hereby made to the San Joaquin Local Health District for aer it to c nstr t and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4/75 f vZ� '� s JOB ADDRESS A NtOCA�TION-- _a_--Ae�I uivJ---�---- ' U Phone -----�-Z -- -----Owner's Namer "Address-------------------------- -- --------------- ---- --- --------- , Contractor's Name------- ------ ------------------ ------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O`th_e�r,,�❑ Number of living units: ---I.- Number of bedrooms___ Number of baths J--_ Lot size _v------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date_______---_-____-) No �ew Construction: Yes to ❑ FHA/VA: Yes Ej4o to❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / /'1 ---�'------ --------- Septic >4 Distance from nearest well______-__Distance from foundation_f�____-_-__.Ma/t�erial.-�.- -_____._ No. of compartments--_-_-3-_-_____-__.__Size��o,,-I$_ l__ �---Liquid depth___---/1�_.__.__ Capacity.. .C�0.0...... Disposal Distance from nearest well__ST.t__r_-.-Distance from foundation.�P_-�-------Distance to nearest lot line._'S____.-...._ Number of lines---ZZ Length of each line----��J_./� __--.Width of trench:,_}X-,1--------------------- j!____--Total len ------------------------ 01_ Type of filter material__�_/�__ �c--- __Depth of filter material___ .___._ gth___-s �17 16 Seepage Distance to nearest well-__/_h_G�._#____Distance f{om foundation___._l�_.�__..Distarce to nearest lot lin _ ________._ Number of pits----- Lining material__.- Size: Diameter-_-24!.-?------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._---___-__----____---_____-___.-.--..-.-. S ❑ Distance to nearest lot line-----------------------------------------------•------------------= ----------------------------------------------------- ----- 1n O Remodeling and/or repairing (describe):------ ------ ------ -•- ----•--- -----------------------•------------------------• 3 ----•----------------------------- ---------------------------- --------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•----------•------------•-------•-------------------•----------------------- ------- >� ----------------------------- ---------------------------•---------------------------------- --------------------------------------------------------------------------------------- ------ I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a s, and rules d re ulations of the San Joa uin Local Health District. _ `a" -------------------------------------- (Owner nd/or Contractor) ----------- j- B ------------ y '=�' ---------------------------------(Title)-- �---`------------ --------------- --- --------- Y (Plot plan, showing size of , I ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - �` ----------------------- DATE 11 ''Rl ---------------------------- REVIEWEDBY------------------------�----- ----------- -- ------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED------------------------------- -------------------------------------------------------------------- DATE----------------------------- ------------------------------- Alterationsand/or recommendations----------------------------------------- --------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------ --------------------------------------------------------------------------------------•--------------- --------------- ----------------------------------- --------------- ---------- -----------:---------------------------------------------------------------------------------------------------- ------------.----------------------- --------------------I--------------- -------------------------------------- ------------------------1----------- ------------ -------------------------------------------------------------------------- ----------------------------------------- _ --------------- ---------------------------------------------------------------------------- ------------------------ ------- --------- ------------------ --------------------------- FINAL INSPECTION BY:. ¢_.., r• <; f ------------ Date '' SAN JOAQUIN LOCAL 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.0 O. �,.. .. .. - w