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FOR OFFICE USE::. q APPLICATION FOR SANITATION PERMIT Permit No. _D!,rs _.... 5•_ ------------ --- -- --------- - ------ ---- -- ------------------------ ------ - (Complete-in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued ' Z{o�- 170--f Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta 1 the work herein described. This application is made in comp�liiprice with County Ordinance No. 549. N TE JOB ADDRESS AND LOC AT 01 PF__.OLEA-�-1)E Z—R F -----PEA-e- 4— S---------- -------- Owner's Name-------------------- ------1.-_U -T_C7Aj------- Sa------ -- -------------------------------------------- Phone--------------- -------------------- Address----------- '. _ -.. Qx 3- --••-•-- - I Contractor's Name---------t0-lo-c AI IF-9--•------------- --- -------- --------------------- ----- ------ Phone------------------------------------ Installation ----- ------------- ------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I---- Number of bedrooms -r�Number of baths J---- Lot size ----- --- -------- -------- -------------------------------- � Water Supply: Public system ❑ Community syste ❑ Private Depth to Water Table - - ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ZA/VA: obe E] Hardpan ❑ Previous Application Made: (If yes,date_-_-------.--.--,._- l No Er----New Construction: Yes El No Yes ❑ No j 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 from foundation------------------- Material --------------.-_--------_--------..----------. tF *j t\A:�— No. of compartments-- ---------------Size---------- ---------- -----------Liquid depth------ -- ....... --------Capacity-------------------=--- Disposal Field: Distance from nearest well.......'S:0__Distance from foundation------10------_ Distance to nearest lot line-- LSTjn C Number of lines------------/---------------------Length of each line---------------f��--------Width of french......--.-------- .-d—A7t—App, Dp• Type of filter material--- of filter material---rL �_____-Total length--------------15-------_----------- Seepage Distance to nearest well-__._-__5—D----Distance from foundation----lU_--------- Distance to nearest lot line__.--5-�-_ Number of pits___ _ ____________.__Linin material__I% ._--K - Size: Diameter. .-__.--_ .. g G �� 6Depth---- ---------------- Q ; Cesspool: Distance• from nearest well ----------------Distance from foundation.............---- lining material---------------------------.--_------. ❑ Size: Diameter- -- --------------- ------Depth---------- ---------------------- - - - - -- ......Liquid Capacity---------------------------gals. Privy: Distance from nearest well -------------- -----------------------------..--Distance from nearest building------------------------------- .-----. ❑ Distance to nearest lot line ------------------------- -------------------------------------------- -------------------------------------------------------------- -- Remodeling and/or repairing (describe):------------- -----------------------------------------------------------------•-------------`------------------------•-. --------------- --------------------------- ---------------------•----------------------------------------------------- -------- ---------------------------------- ------------------------------------------ ---------------- 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. Cpl (Signed)-------------------- - ---- - (Owner and/or Contractor) - O _ By:---- (Title)-- ----------------- ---------------------------- ---- (Plo+ plan; showin size f !- , 1 ®tion'of system in relation to wells;$uildings,-e+c.,-can be'placed-on reverse-side):-- � FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY- —ice ' --------------------------- DATE --1 --.#� . REVIEWEDBY---- - ---------------------------- --- - - ------------------------------------------------------------------------------ DATE------------------------------------------------------ BUILDINGPERMIT ISSUED-------- -- ------ ------------------------------------------- --------------------- --------------- DATE------------------------------ -- ........-------------- P Alterations -- -------- Alterationsand/or recommendations------------------ --- - -------------- --------------- --------------------------------- -----•-----------------------------------•----------------- ---------------------------- ------- -------- ----------- - ------------ ------------------------------------------------------------------ ----•r------------------------------ ------------------------------------------- ' FINAL INSPECT[ /,,1 ._ Date----- . ----- - .......... ..."..- _ 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 E.H.9 2M 1-67 Vanguard Press .. -