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FOR OFFICE USE: ---------------------------------------- ---- ------- APPLICATION FOR SANITATION PERMIT Permit No. /� _J-_V -------------------------------------------------- (Complete in Duplicate) Date Issued .-_---/�,� -_____----- ...... --- This Permit Expires 1 Year From Date Issued Application is hereby mads 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. JOB ADDRESS AND LOCATION...--# 3 _ra fl,4 ------------------------------------------------------ Owner's Name-------.- --=--- rtl - .- --------------------- Phone---------- Address --�?,I -------------------------------------------------------------------------------••----------- ----- ------ .. ..--_.. Contractors Name- c---l,-��=' n�� ----- : -- ICrCr-`------� 4. -..-.-----3•------r--------- ----- Ph°e•------ --------------•---------- ! Aa Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---� 1 -- Number of bedrooms -;;I._ Number of baths j---- Lot size -------'�`C1X1-l•'.:--.0-------------------.---_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:- Sand E❑ Gravel El Sandy Loam [] Clay Loam�� Clay ❑ Adobe I-] Hardpan11Previous Application Made: (If yes,date--------- -----------) No ❑ New Construction: Yes ❑ 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 neo est well-----—----------Distance from fours iation--.-1A-.-..---.Material---- ----------------_-- No. of compartments---------f)—---------- --. _-------Capacity-_.--_I_-az_-- -_ Disposal Field: Distance from nearest well.------ -Distance from foundation _lam__ _.Distance to nearest lot line-----�7------- a7r_�r Number of lines---- 3-------------------Length of each line--.--- d----------------Width of trench---,---)-----`)---x.-. -o-- ---/ f �Type of filter mai�rial _____De th of flter material___________________-_Total len ---.-.--.-.---_-- -1- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------_-----_ ❑ Number of p;fs___'J----------------Lining material------ ---.--------.--.Size: Diameter----------------------Depth-.------------------------------- W Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- OQ ` ❑ Size: Diameter-- :---- ------- -----------_-Depth---------------- --------1- -----------------Liquid Capacity-- -------- gals. 6' Privy- Distance from net rest well-------------------------------------------- ---Distance from nearest building___------.-.-.-------_-.-.--------------. N • , Distance to nearest lot lire---------------------------------- ---------- .-..------------------------------------------------------------------------ - Remodeling and/or repairing (describe):---------------=----- ------------------•---------------- -------------_------- ------------------------------------------------------• 0 tl ----------------------------------------------------------------11=---------------------------------------------------------•--------------------------------------------------------•---------------------------- ------- ri -- 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) By:-------------------------------------------------------------------------------------------------------------------------------------)Tale)------------------------ -------- -- - - - •------------- (Plot ----- - ----(Plot plan, showing size of lot, location;of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ._ - ____ __ _:_ -'�-�-------------------------------------------------- - DATE----�-_77-6.1.6 ------ REVIEWEDBY------ i --------------------------------------------------------------- DATE------------------------ ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------- - Alterations and/or recommendations:—------------------------------ --------------"--- -----`-------------------•---------------------------------- t t -------•-- ----•- -------------------------------------------------------------------------•--------------•----- ------ i •-------------- --- ----------- - ------------ ---- -------i------i - ----------- --------------------------------------------------------------- ------------ ----------------------------------- -------- l FINAL INSPECTION BY:.- ` ------------------ ----- I 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.0 u.