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FOR OFFICE USE: - -------------------------------------------------------- f - ------------ ---- -- ------------ ------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued . This Permit Expires i 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. JB IDDRESS AND LO ATION---!'r �Y: Ig -----------1 ..------ --.-- F-.----0H_t� ---- ---- p"' �+_�f_------- D --- Owner's Name-----------------1H Lr ---•----••-------------------- ----------------------------------- ----- -- Phone--------------•-------------------- Address----='-------------- I .--1- 10 ------1 a�0----------ESC ...01� -� —�_. -------------------------------•------•- ------------ ------------------------- Contractor's Name----------- R --------------------------------------------------------------------------------------- ------ Phone----------------•-------..----- --- Installation will serve: Residence ❑ Apartment House ❑ Commercial•Trailer Court ❑ Motel ❑ Other ©-F?E]5) P?06M Number of living units: -------- Number of bedrooms ___.____ Number of baths ______ Lot size ------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 4 5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2 lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________} No New Construction: Yes ❑ No �A/VA: Yes ❑ No R-- TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: ---" -- No"se tic tank o�cess ool- ermitted-if: ublic-sewer-is-available within'200-feet. ~-@`'�' = - - _ -�A I P p_ p" I P )�f Septic T k: Distance from nearest well___4�� --------Distance from foundation---I _--------Material __- No. of compartments-------2�-------Size__3_X_V.A__�___-___Liquid depth__/� ___-___Capacity....SP_o---- Disposal Field: Distance from nearesf w//ell.__,5C'�-----Distance from foundation----f.0.........Distance to nearest lot line_:_----- „p [a]� Number of lines------------1---------------------Length of each line-------- -S_-__---------Width of french------- _� ____..____...__1 Type of filter material�---R C�Ni_Depth of filter material____._I_�h___...___Total length_____________�s_________________-_ Seepage Pit: Distance to nearest welL._J40-------Distance from foundation----,l_r0___---------Pistance to nearest lot ©� Number of pits..... __y""1Lining material Size: Diameter-_T`X---9......Depth--------/a__'__.___..____ Cesspool: Distance from-nearest well--------------- Distance from foundation------------_-------Lining material _..______.__.__________._____---� Size: Diamefer ---------------------------------Deth---------------------------------- ----------------Liquid Capacity ---------- als. ' Privy: Distance from nearest well______________`_.____,-------------Y:---------Distance from nearest building....______.__.___________-____..__-..__._- r ❑ Distance to nearest lot line--- ------=-------- --------- ------------------------------------------------------------------------------ --------------- ------ Q r � Remodeling and/or repairing (describe):------------------------------------ -------------------------------------••------------------- ----------------------------------------------- ------ ------------------•------------------------------------------------•----•-------------------------------------------- --------------------------------t--- -------------- ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------•--•-------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. p J/ , (Signed)----------- �i-ff-0�---- —-------------------------------------------------- -------------------------------------------------------(Owner and/or Contractor) j a, ... . y ._----- 13Y-- --------------------------------------------------------- -- -(Tit a ---------------------------------------- -------- -,-i (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------- ” 25 - �� DATE --------------------------------------- REVIEWEDBY---- --------------------- ---------------- - -------------------------------------------------------------------------------- DATE------------------------------------------ ----------------- BUILDING'PERMIT ISSUED------------- ------------------- ---------------------------------------------------------------- DATE------------------------------------ - --------------= Alterations and/or recommendations:----------------------- ------------------------------------------------------------•----------F------------------------------------------ ------------------=----------------------=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- -- -- ------------. -------- -- - ---------- --- - -- ---- --- - - ---- / ---------------------------------------•------------------------ ------------------------------------------------- • FINAL INSPECF•F9�:.. G ;r-- --- - --- /—- .Date.------. � .``�� ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California