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I-UKUWCE USE: _ ...__.�y•. .r . .� E APPLICATION FOR SANITATION PERMIT Perm _ - q - I -- --- ----------------- it No. (Complete in Duplicate) ---"-.--- This Permit Expires 1 Year From Date Issued Date Issued __ -� __- � - - --------------------------- -------- ------------- -- Arlication is hereby made to the San Joaquin Local Health District for a permit tt�construct and install the work herein described, is application is made in complianc with County Ordinance No. 549. A- n i = 2-S`7— 2Zu— p(� �tiPaN C JOB ADDRESS AND L CATIO _��1p�-----.. ... ag --.-- - - 10-- - -�- gip. -• m e R ._ c Owner's Name------------" 6- ---.J Q_ e _-------------------------- ---- Phone. - - Address---------------------- - �------------, Contractor's Name---�---! NTH_QA1 ---d-"-- QIV--- ------------------------------- - -------------------------------------- Phone--------- ------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Diet, OEr Motel ❑ Other ❑ Number of living units: ----V Number of bedrooms ---I__ - Number of baths __._�__ Lot size �}��_A�E-•__-_-_ Water Supply: Public system ❑ Community system [❑ Private ff�Depth to Water Table O57—ff. f Character of soil to a depth of 3 feet: Sand [Gravel [❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [] Hardpan Previous Application Made: (If yes,dote... ......:........1 No New Construction: Yes ❑ No FHA/VA: Yes ❑ No F�� TYPE OF INSTALLATION AND,SPECIFICATIONS:' o septic tan k orcesspo`oF'perrntttedTif'pukilic sewer iss available within-200"feeta�``'A'`"'==�- -� Septic T nk: Distance from nearest well---- -_-Distance from foundation----1_Q-.-.-.-..Mater'' i__.CIONC- -C.TF _----- ( No. of compartments-------2:.----------Size--*3,X q --5__--=_--Liquid depth-_ - - -=-------Capacity-.-go eJ_"---- Disposal .Field: Distance from nearest well---.,!37(?....Distance from foundation.-t----------------Distance to nearest lot line__.��____---_. k Number of lines-----._-_"_.�----..-"__---_____-Length of each line------$70--------------.Width of trench-.-._2 --------------------" Type of filter material:__ = C-.-:-Depth of filter material----Zq_..........Total length---_------$?.--------------------- 7 ! Seepage Pit: Distance to nearest well_,__ P_0—.-._-_Distance from foundation----/0---------- Dista ce to nearest lot line-.._----------..- E2i,-�. ; Number of pits.------I-------------Lining material__R_0.<7�-X,. _.Size: Diameter-_�4x - ------- Depth_"._./ --------------------- Cesspool: Distance from nearest well..-------------;--Distance from foundation--------------------Lining material---------------._._."_-----.---"----- ❑ Size: Diameter-------I--------------------- ....Depth- --------------------------------------------------Liquid Capacity------------ --------------gals.' Privy: Distance from nearest well____________--------------------------------'__-Distance from nearest building--------------------------------..____--- ❑ Distance to nearest lot line----- ------- Remodeling ---Remodeling and/or repairing (describe)-------------------------------------- ------------------------------------------------------------------------------- ------------- ------------- ---•-------------------------- ------------------•-----•----------------------------- -- '----------------•-------•------------------ ---------------------------------------------------------------------------------------- a ------------------------------------------------------------------------- t t t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. , (Signed)--------- A..... ---- -------.(Owner and/or Contractor) �. } $Y�-------------------- --------------------------------------------------------- ------ ------------- --------(Title) u =. . ....r. i:_.-- 1 (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY c� APPLICATION ACCEPTED BY------- + 'Q ----------- ------------------------------------------------------ DATE------ 2 REVIEWEDBY-------------------------- -------- ------------------------------------------------------------- ------------------------ DATE---------------- 1 BUILDING. PERMIT ISSUED------------------- ----------------------- ------------•- ------------------------------------------ DATE. _= -------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------- I ------------- --------- --------------------------- z r ---------------------------------- .------ — - - -------------------------- ----------------- --- - -------------•---"--------------- --------------------------------- - -------- -- ....... - - - ---------------------------------------- -- FINAL IN5PECT10 Date 2 -�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.