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FOR OFFICE USE: `c r ---- ------- ------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ....��j(,�.....� -------------------------------------------- ---------- (Complete in Duplicate) Date Issued ._.. --___-___ ---_ -- _---------------- -------------- This Permit Expires 1 Year from Date Issued Applicatio is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des�.ibed,R This pl' ation is made in compliance with County Ordinance No. 549. L� �� /v CORrJ.ER n _ JOB AD ESS AND LOCATION.A-�__F.R...PQ.E.j�.�j _47----/-Q.VISIF—--------1400-------I. ...... Owner's Name-----AITCg----•--UN)-- Jr.'i--------1 __uC,.-14----- -C- _H-pQ L-------------------------------------- Phone------------------------------------ Address-----------Y -------E&S—F---- Vr l-S-iF�' -1--TF- ---------M-77C/----=------------------------------------------------------------------------ Contractor's Name-----0Wt4It --------------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence @'Apartment House ❑ Commercial E] Trailer Court [-] Motel ❑ Other E],Number of living units: _I.... Number of bedrooms -_2--Number of baths I--- Lot size -----©©V/S_��E_�- _------------------ Water Supply: Public system ❑ Community system ❑ Private [f] 'Depth to Water Table Q____ ft. 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 e New Construction: Yes Rr'No ❑ FHA/VA: Yes ❑ No FT'-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.j__ Septic Tank: Distance from nearest well----5!P------Distance from foundation-1.0------------Ma erial--CD G .1=T) _ No. of compartments.--._ 2 .. Size_.3.--- -:Liquid depth , /y__Capacity-----:Tao .... Disposal Field: Distance from nearest well____S.0----Distance from foundation---1.Q---------Distanc8''o nearest lot line-.:5�...... Number of lines._.____--. - --------------- [� �.-__...............Length of each line------- of french------ .--__-.__.-.-_ Type of filter material-----F_Q_C._Depth of filter material-----1-3----------- Total length---------------7_5--_----_----.-..- Seepage,Pit: ; Distance to nearest well---------------------- from foundation.............. ....Distance to nearest lot line._..._.__-.----- ❑ Number of pits-------.------_.-----Lining material-----------------------Size: Diameter----------------------Dept h---------------------------------- !f Cesspool: Distance from nearest well..............._Distance from foundation--------------------Lining material-_--_--_...__.__.__-___.-..-__--.-- ❑ Size: Diameter-------------------- ----------------Depth----------------------- ---------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------.-------------------JDi-stance from nearest building------------------------------------------ e- ❑ Distance to nearest lot line-------------------------------------------------•------------------------------------------------------- - ---------------------------- Remodeling aid/or repairing (describe) - - ? ---------••--------------------------------------------------------------••----------- --------------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)-.- � L?'' ----------------------------- -------------..-------------------------------------Owner and/or Contractor (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---------7L--_t_R-0— ------------------------ DATE----------� -�l �—s�_-------------- ------------------------------------------ REVIEWEDBY-------------------------------- ----------------------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------- ------ DATE---------------------------------------------- -------------- Alterations and/or recommendations:---------------------------- -------- - ------------------------------------------------•----------••----------------------------------------------- -----------------------------------------------•--------- ------------•--------------------------------------------------•-------- ---------------------------------•------------•------------------------------ ----•--------------- -------------------•----------- ------------ -------------------------•-----------------------------------•-••-------------------------------------- -----------------------------------------. ----------------------- -----------•----------------------- -- ----------------------------r------=- --•------- --------------------------- ----------------- FINAL INSPEC�N B Date-------/f ------------------------ 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.CO.