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FOR OFFICE USE: -------------------------------------------------------- --"--------"-"---- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. --- ------------- ----_-_--_-_-- --------- (Complete in Duplicate) Date Issued --------------------------- } This Permit Expires 1 Year From Date Issued -------------------- --------------- - um Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaq _.This application is made in compllanc with County Ordinance No. 544. ; .`_ ZAP ` IDYL—Z7— -------- ------- TF1 - JOB ADDRESS' AND LOCATIO -- --- ------f��,�--- Q"�-.---- f-v�L�---c�--'---- --�,��N-D��--' �•`_ Owner's Name-------------------- Tam ------- / "L. " -------------------------------- --------- ------------ - Phone.-----------------------------•---- ------------------1V1 r --------------.-.----•------------------- Address---------------------------- y-01------------•----------=---�`--------- " --------------- -------------------------------------------------------- Phone � Contractors Name-_.__��-�4-�-�•-•---------•------ --------------- Installation will serve: Residence ®/Apartment House [�~ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Lot size /5 Q rU ------------------- Number of living units: -t----- Number of bedrooms -3---"Number of baths ., . a Water Supply: Public system ❑ Community syste ❑ Private �epth to Water Table "_. - f}. Character of soil'#o a depth of 3 feet: Sande Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ r FHA/VA: Yes �No [IPrevious Application Made: (If yes,date__.-_-,--'`------- 1 No RNewr Construction: Yes o ❑ !« TYPE OF INSTALLATION AND SPECIFICATIONS: _ _ -- - __j! • ' .� �.�.._ [No septic tank-or cesspool permitted-1f public sewer is available within 200 feet. 1� - ( � CT Maur• l"--- v -- --- Distance from nearestwell_ .�.v_-__Distance from foundation--- SepticCapacity Ca acitY ® --{, Z -----Size depth--- P No. of compartments..,_ ".__._. . -� Distance to nearest lot line__-�".._.._. Disposal Field:,. Distance.from near t hell: --__ �t�, yf m fo ndatian.""-/___ Width of trench_--__✓ ,----- ------ Number of lines_-- ------ --------- ` eng�h of �Ie--- i� t +� 00" _ Total length --------- r'�Q r,l Type of`filter ma erial-p-R C, -5''-Depth of filter material___-.-�"�_-_-,. ".- 9 Seepage Pit: Distance to nearest well_:"'._"""-- --------------------------------------------------- _---_--Distance from foundation--------------------Distance to nearest lot line__._"___""- Number 4pits------- ---- --- --Lining material-----------------------Size: Diameter. - Depth - 1 ` r i I Cesspool: Distance from nearest well ___.-"Distance El from foundation- material-------------- .___------------- �I Li uid Ca acit gals. k ❑ Size: Diameter__`_-A--------�---------------Depth--------------------- ------------- - ---------- 9 n Y - Privy: Distance from nearest well:_--------------- ------------------------------Distance from nearest building-.r----------------------------------- ❑ Distance to nearest lot line---------------- - ------- ------------------------------------------- -------------------------------------------------------- 1 'Remodeling and/or repairing (describe)---------------------------------- ------------------------------------------- ----------------------------------------------------- -------------------------- -------------------------'---------------------------------------------------- ------------------' I hereby certify that l 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) T -----------.:;----------------- ---------------- ------------ --------(Owner and/or Contractor) - L . .. = -"`B- - ------------------------------------ (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 # DATE-. -` I APPLICATION ACCEPTED BY-._..----- ' S__,V------- ----------------------------- REVIEWED BY--------------------------------------------- ---------------------- ------------------------------------------- ------ DATE------- ------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------- ------------- ---------------------------------- DATE------------------- ----------- ----------------------------- 50-L Alterations and/or recommendations:___"_ . . --- --------------------- ----------------- ----- ------ ---- - ----------------------------------------------- -- --- Date-- ------------ � --------------------------- ` FINAL INSPECTION ---- i SAN JOAQUIN LOCAL HEALTH DISTRICT � 1601 E.Hasellan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.0 O. r.