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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .. ..�'�..�.. --------------------------------------------------------- (Complete in Duplicate) rr 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 thejr herei &sc�iibed. This application is made in compliance with County Ordinance No. 549. s, / JOB ADDRESS AND LOCATION l` G1'' � /..l1.Qft�'-f i ��. i tk � _.,/at A ................... Owner's Name 6_ lsr -' ---- ------------ - Phone. Address /� x! .el` •�--�f� � !'t ?71---..._ , .f---------------- Contractor's Name-------- � "� ------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence/ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I-_._ Number of bedrooms _-_ Number of baths ..7-- Lot size Q� ��- . ------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablett. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Uq''*Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No ®0' New Construction: Yes Z31No ❑ FHA/VA: Yes W4-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest w II---�Q j._Distance�ro�m`�undation__ __ �--------Material_&_ . �� ---------- No. of compartments-_ --______-______--Siz% _� -_ Liquid depth-----'�f-__................Capacity.,/'7-1Q-c;'__- Disposal Wield: Distance from nearest well_-�%_Distance from foundation---X�.......Distance to nearest lot line_10_..-----__ ength of each line_ ___ Number of lines_______`�__._..�____ _ _.__. ,1��-___.� Width of trench_.r�•_____ _,_�,..__....._-_--.-- Type of filter mate ria ---Depth of filter material__ e __:__.___Total length_r9l`a '_______________________ oe / R Seepage Pit: Distance to nearest well__/f -_Distance from fo dation__sJ...__..Distar,ce to nearest lot liners` _____._ Number of pits_._____-___-Lining material/ '`f __ __Size: Diameter. -------Depth __ i �_ 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------- ---------------- ----------------------------------- --------------------------------------------------------------------- 'Cf -- --------------------------------- Remodeling and/or repairing (describe):-------��/�,G ---------------- --------------------------------------------------------------------------------------------------------•--------------------------------------•------------------ ------------ 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 andVreulations of the Sa Joaquin Local Health District. ---- -- --- --- - - --------------- --- -------------------------------------- for Contractor) (Signed) - r� - � 6 By:---------------------------- ---- -- ------------------------- = `--------(Title) C ``/!G - (Plot plan, showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------- --- --- - - -------------------------------------------------------------------- DATE----s?-�-//---------------------------------- REVIEWEDBY----------------------------------- --- - ---- -------------------------------- --------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED--------- ---------------------------------------------------------------------------------------- DATE.------------------------------------ ---------------------- Alterationsand/or recommendations----------------------------------- -------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ---------------------------------------------------------------------------- -------------•----- ---------------------------------------------------------------------- ---------------------------- --------------------- ------------------ ---------------------------------- ............ - ----------- -------------------------------------------------------- ---------------------------------------- -------------------------- ----------------- --------- ------------- --"----------- ----------------------------------- --------------------------- ----------------------------------------------------------------------------------------............ 01 FINAL INSPECTION / ---------- -------------- BY:.- -��"�v�..��;.i:d��="'; �---------------------- Date.._ '.�'r�t0-�. ------- - 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.CC.