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^F OFFICE USEle /S / _l --------------------�_ itl. APPLICATION FOR SANITATION PERMIT Permit No. -- --------------------------------------------- - (Complete in Duplicate) Z/ -------------- This Permit Expires 1 Year From Date Issued Date Issued ---.---._ _� _� Application is hereby made 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. S49. JOB ADDRESS_—Ablp LOCATION_2-K 1----C,l ----------------- Owner's Name-----IfV--- ----.--A-----T(-- -------------------------------------------------- -----I------ - - ------------------------------------ Phone------------------------------------ Address-------*r ----- --------------- �---`�-- - , Contractor's Name ---------•----r---- -------•------------------------------------------ ------- --------------------------------- Phone-----------••----------•--•-------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --q---- Number of bedrooms 3-_ Number of baths _:_ _ Lot size _74./Z IK--- --__-__.._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3—Hardpan ❑ Previous Application Made: (If yes,date -- -- -) No New Construction: Yes � ❑ FHA/VA: Yes ❑ No [J— TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Septic ink: Distance from nearest well-________________Distance from foundation k__ -----.-.-_.Mater�aL..__1_ _____..-----------------____-__-___. No. of compartments-.....2----------------__Size-_3_xJ x__` _.__.__-Liquid depth...._.-..-..---_-..__Capacity---f'a_7___—A Disposal Field: Distance from nearest well__-"- -------Distance from foundation__f4........_._.._.Distance to nearest lot line---�_'_ Number of lines----__--_Z--------------------Length of each lina__.ffl-w-_L!l v__--..Width of french----- Type of filter material-�4.n_.4r� .......Depth of filter material_1,�_.``._.-------.Total length l_1�_?-:----._ Seepage it: Distance to nearest well-_-------------------Distance from foundation-__4D------------Distance to nearest lot line.-____.-- Number of pits------ -_.-------Lining material-- ��._..Size; Diameter----- .3_`*------Depth---Z-7',.-----__ V►! Cesspool: Distance from nearest well------------- ---Distance from foundation....................Lining material------------------------._-_---------- ❑ Size: Diameter------- ------------------------- --- Depth-------------------------------------------------...Liquid Capacity------------------- -------gals. V' Privy: Distance from nearest well------------- --------------- -------___Distance from nearest building----------.-------------------._..------- . O ❑ Distance to nearest lot line ----------------- ------------------ ---------------------------------------------------------- ------ ---------------------------- 0 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. (Signed)------------- - ----------- --- ----------- -- ----- - ------------------------------------- ---------------------------------------------(Owner and/or Contractor) BY:----------- ---(Title)--------- -------- (Plot ppjan, showing size of lot, location of sy tem in relation to wells, buildings, etc., can be placed on reverse side). Q FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 1------ ------------------*-------------------------------------------------------- REVIEWEDBY-------------------------------------- ----- -------- ------ -------------------- ----------------------------------------- DATE----- BUILDINGPERMIT ISSUED-------------- --------------------------------------------------------------------------------------- DATE---------------------------------------- Alterations and/or recommendations:.___--- ._._r._E'l._ f_rc - _-, -y= = ._ __ � --------------------- ---E-r—rte --- -- /'Y `- -- r'c ------G`� (------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- --------------------- -• ---------- ---------------------------------------------------------------- ------ ------------------------------------------------------------V••------------- INAL INSPECTION SY:....-A ; ------ Dae � .�---------- ----- ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltor+. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californla Lodi, California Manteca, California Tracy,California F.F.co.