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OFFICE USE:/�-.OR y APPLICATION FOR SANITATION PERMIT Permit o. zl ' T �C (Complete in Duplicate) - ate Issued. ---- 4t--LS' t`!� -- This Permit Expires 1 Year From Date Issued -ate Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h cribed. This application is made in compliance with County Ordinance No. 549. A JOB ADDRESS A LOCAT40N.....CmRzo-----a _'-'J� -�7--------------- Owner's NamePhone. ----------- ------------------------------------------------------ ------- Address-----•----- t /-----.e_-_,X ---- --- < «------------ -------------------------------------------------- ------------------------------- Contractor's Name_____ _r__ _ ._ ._ .______ �.T _'. �_Y .� T p� C ` �/1 ... Phone ' . ll Installation will serve: Residen �,/A artment House Commercial Trailer Court Motel Other l_7 P ❑ ❑ ❑ r /i❑ � El Number of living units: ---I---- Number of bedrooms .3_- Number of baths J... Lot size ---10 `> _._____________________ Water Supply: Public system [Community system ❑-- Private ❑ Depth to Water Table t&,5,ft. 't— Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No 9?""New Construction: Yes EY"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)! Septic Tank: Distance from nearest well ----Distance front foundation___ a._.__,.__.Material' _ Q/ No. of compartments___. . --------- th _ - '.. --. _. Capacity- -- 64 Disposal field: Distance from nearest well- ...Distance from foundation _ _r _... _.Distance to nearest lot �ne_____ E Number of lines---- _ __ __ __________ __Length of each line�jrd) .Wiclth of trench.__:_ _ Type of filter materiaU;&. 10"(Depth of filter material_-wM-------------Total length___..-.o?4; -- -----------------. ,Q�, Seepage Pit: Distance to nearest well-----------------.----Distance from foundation___________________.Distance to nearest lot line______..__-_-___ J ❑ Number of pits---.------ --------.-Lining material_.__ _ _ ------------Size: Diameter-------------- --------Depth_____-___.__.___--________--_ Cesspool: Distance from nearest well ___._________Distance from foundation_- ----------------Lining material------.--------- --------------------I N 171 Size: Diameter----- --------------- ----------------De th---.-------------.----.------------------------_.-Liquid Capacity gals. Privy: Distance from nearest well------.----------------------------------- --- __Distance from nearest building________________________________________ ❑ Distance`fio nearest lot line------.-_------------------- --- -- ----------------•-•--•-----•-------------------------••---------------.....--- �09 Remodeling and/or repairing (describe)------------- --------------------------------------------------------------------------_----- ----------------------------- t% ------------------------------------------------------------ -----------------------------------------------I------------------------------------------------------------------------------------------------ -------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 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 Ax F APPLICATION ACCEPTED BY----------- r---4o------------ ------------------- ------------------------- DATE ------------------------------------- REVIEWEDBY-------------------------- --------------------------------------------------------- ------------------------------_........ DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------------ --------------------------------------------------------------- ----------------- DATE------------------------------------------------------------- Alterations and/or recommendations- sins .e *P - �n�2G. fitsl�( = crn "`. ,� � - - - - - - - ---------- -•-------- - _- - --- ----------------- ------- y ,,�, ,�.�.�, . cry e •.r` ----lam'--- ---------- o�z.-- -------- ---- ' I Rji�i�G fF��Qtrap�.a+o'1� .sW.- ez alv C Flo Y .r FINAL INSPECTION BY:..--- . -- ---- - -- ---- ----- ------ Date I'�' 5- ----- ------ — tet' 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.00.