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FOR OFFICE USE: ' r APPLICATION FOR SANITATION PERMIT Permit No: ..1�� -- (Complete in Duplicate) --- ---------- Date Issued --- - - --- -- --- --------------- This Permit Ex ires 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. 4 This application is made in compliance with County Ordinan e No. 544. 0,?46,11 JOB ADDRESS AND LOCATION------- �__-_----- ------?. -?----- ---- Q --= , lL°-r_S 0---------------------------------= Owner's Name------- J, UA,-t-III*------------------------------------------------------------------------------------------------- Phone-Af� Address----------- ... �Rc.�ti ---------- •-•------••----------------------------------------------------- •---------------7-------------------------------------- Contractor's •-Contractor's Name---------- —----------••--------------------------------------------------------------------------- ----------------- Phone...'3 -Z-_---------- Installation will serve- Residence ', Apartment House ❑ Commercial ❑ Trailer Court. ❑ Motel ❑ Other ❑ 4 Number of living units: _>_____ Number of bedrooms __ Number of baths -------- Lot size _-6.12-A -� ---------- 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 E] Clay ❑ Adobe . Hardpan ❑ r ; i Previous Application Made: (If yes,date--------------------) No K New Construction:"°=Yes No ❑ FHA/VA: Yes ❑ No. TYPE OF INSTALLATION AND SPECIFICATIONS: E '� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T SePtc Tank: t t well �__...__Distance from foundation dation___:-��--�� ...Mate{r ial----' j-:----------- K-� Liquid de { -_-_� f .�_____.Noof compartments X _ Z. SR Disposal Field: Distance from nearest well........ ------Distance from foundation.--._..1.0_ __..Distance to-nearest lot line______..._. . Number of lines______.____,.r---------------- Length of each lirie:40 ' ❑ �� _ _______ch __________ TYpe of filter material_�} b_C.. - ePt of materia_____(-I-"l------:.--'..Total l length-: G6------------------------------- Seepage ---------------------------- SeeP 9e Pit: Distance to nearest well------------ -------Distante from foundation--------------_- "Distance to nearest tot line -----------. Number of pits------________________Lining material-------------------- --Size: ismeter-------------_----- i_ f _-Dept h------------------_-__-- Xr Cesspool: ) Distance from nearest well-----------------Distance'from.foundation ----------------.. Lining material_ ^,_._.____ -------- ❑ Size: Diameter-------------------------------------Depih-------- ------ ------Liquid Capacity -- -- -_--gals. Privy: I Distance from nearest well-----____________________--___.- -fit._ Distance from nearest building------------------------------------------ 1 07 ❑ s Distance to nearest lot line--------------- ---------------------- r '------------•----------------------- ----------------------------------------------------- 1) - Remodeling and/or repairing (describe) _ �r - -------= .. - -: -------------------------------- -------------"----------------------------------------------------------------------------------------------------- ----- - -------------------- --- ---------I-hereb---certif that I have prepared pp .: ., =-----------------•--- -------------------------.----- � --- ------------------------------------- -- q dance with San Joaquin County y y that'the'work will be done m actor e re orad this application ordinances, State aws, and ru and regulations of +he San Joa uin Local,Heal+h District. (Signed) r` -_._.Owner and/or Contractor B --------------- -- ---- ---------------------------- --- -- Y�-----------------------------------------------------------------1. - - - �- -_- -----:-------g---- ,,--- �----{Title- -'-- ) (Plot plan, showing size of lot, location of system in..relation_to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY .kr 1 APPLICATION ACCEPTED BY-- �-�' ---- ----------- - ------------------- --------------- - ------------------- DATE.-- �' s----------------------- --- REVIEWED BY--------------------- -- -.___-_ DATE----:;-----___ BUILDING PERMIT ISSUED--------------------- - '------------- ---------------------. DATE------ `------- - Alterations and/or recammenda+ions__________ ___--- ------------------ ------------------------------------------- ----------------------------------------------------------------------------------------------------•---- --------------------------------- --------- -------------------- --- ---------------------- ------------------- ------------------------ ----------------------------------------- ------ --------------------------------------"-•-•----------- ----------------- ---=------ ------ FINAL INSPECTION BY:-- ; -C7--- -------- -------- SAN JOAQUIN LOCAL HEALTH"DISTRICT 1601 E.Maaelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th�Str Stockton,California Lodi,California Manteca,California Tracy,Califoinid.':,., ;