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/ F� ONCE USE: 5 JJ F �{ APPLICATION FOR SANITATION PERMIT Permit No. .1.. . -------------------- -------------- - - {Complete in Duplicate) Date Issued -----------.-------- This Permit_Expires 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. This application is made in compliance with County Ordinance No. 549. ------------------------------------------------ Owner's -- -- -- -- --------------------- 08 ADDRESS AND LOCATION..---- ---`��-- - --- -----9----------- - -- -�-- --��' ------------------------------ - - -- --- ---- - Owner's Name-------- -T✓1�9_----- ----------------------- - - --------- Phone.-------------------------- r Address-----------az t-Aw-,_ P x�r ----------------------------------- Installation -- ------------------------- }9 Contractor's Name-------- Vl- --------------- -------- �� Phone--- 7�'_R_ d__ -- ------------- ---------- ------------------ ------ will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ aa Number of living units: ----t--- Number of bedrooms __-3. Number of bathd�_ Lot size _� 9_ __.9-_�3_1_4),aC--r\_l�1- ID3 Water Supply: Public system k Community system ❑ Private ❑ Depth to Water Table 3,5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ t Previous Application Made: (If yes,date___________________) No New Construction: Yes Nf No ❑ -FHA/VA: Yes 25 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 "�_.-.__Dis#anc �fro)m foun anon___ _ �'� cl ��A;Clr � Septic Tank: Distance from nearest well_____..__ . �C�______._.Material_. G______ __ ______________________ No. of compartments_____.____-- Size_ !i_i p_ _ __Liquid depth___-/. _ _ -- ---_Capacity._AP-0.(l.___6� Disposal Fieid: Distance from nearest well------ -_-_Distance from foundation__/O-----------Distance to nearest I t line---�..-/_. ` Number of lines___--�5__-------------------Length of each line__`j0�-&0i- /,40a 36l of trench_._.-N_ Type of filter material_-'`' _t=__i�.____.____Depth of filter material_____1_�. �___Total length________�`�`Z_- �5eepa Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------- umber _-_____.-___.umber of pits.�---------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- � Cess Distance from nearest well________________Distance from foundation___________________Lining material-------------------------------------- ❑ Size: Diameter ----------------------------------Depth------------------:------------- - -------`� ----Liq:iid Capacity----------------------------gals. r . ., �-:�:r- Pri Distance from nearest well ___ ____ __________ Distance from nearest budding _ - _____ - . . .�.�.__. Distance to nearest lot Line------------------------------------------------ -------- ----------- --------- ------------------------------- ----------------------- I Remodeling and/or repairing (describe)------=---------------------------==------ ------------------------------------------------------ ------------------------------ -----------------• ..+ r ----------- -------------------/'� -----------------------_---------,-----------------------------------------------------------•-----------------------------------'a-�------------------------------------------•------------------------_____..._-._Cgy�pp i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County l ordinances, State laws' and rules and regulations of the San Joaquin Local Health District. —(Signed)..... ------------------------------- ------ - - ------ ---------- ------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------ ---(Title)--------------------------------------- ------ ------------- (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 APPLICATION ACCEPTED BY-- --------------••--•--- ----- DATE-----ter= � A REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------=----------------- ----------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-----------------------------------------------------------------------------------------------•--------------------------------------------------------------- --------------------------------------- -------------------------------=------------------------------- -------------------------------------------------------------------------------------------------------------------- ---------- --- -------------------------------------------------------------- ----•------- --- -----= ----------------- ------------------- ------------------------------------------------------------- ----- ---------------------------------------------------==--" --------------------------------------- c � FINAL INSPECTION BY:--- ---- ------ Date-.-----4'_�`��----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT " 1601 E.Hoxalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street' Stockton,California Lodi,California Manteca,California Tracy,California r+ 14 F.P.0 O. - � �