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FOR OFFICE USE: (// -'rte/ /J'>d-; - ----- ----- 5?t ----AW,Ak------------ y _0.Cw.o________________._ APPLICATION FOR SANITATION PERMIT Permit No. ____ - -- ------------------------ --- ----------------------- (Complete in Duplicate) Date Issued --511 ` j ------------------------ ................... This Permit Expires 1 Year From Date Issued Oe 7— nc fe7 ^,?--I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Orel descrbed. This applications mede_in.com4 liance with County Ordinance No. 549.' � JOB ADDRESS A,9- LO TION.VI4_-,5! le, a/-- �s 4---� Owner'sName--------- - - ----- A ! Pho�ne --�---f dj ----- --••---- Address---------•---- •--•--�� Contractor's Name___-_______ Phone Installation will serve: Residence ®�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms . -_-Number of baths __/__ Lot size __ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 45'41 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan C]I ,. Previous Application Made: .(If yes,ciate________ ------ No R?' New Construction: Yes ❑ No FHA/VA: Yes jp—No ❑ 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__ZP.. _ Distance�rom foundation_..2e! t_________. No. of compartments---,�----------------Size"_,i4_ _ZkS LiquidCapacity,�� ___- Disposal Field: Distance from nearest well.----------------Distance from foundation_-�e-_--_--_-Distance to nearest lot line_-----""�"_____ ®� Number of lines�__�__-_- Length of each line__�t�________ _________ Width of trench_•9-.-_____._.______._-_-___-_-_r 'f Type of filter material_._-_Depth of filter material__A0:"r_-__ Total length___ �_Q_ __________________ Seepage Pit: Distance to nearest _.______Distance from foundation____ dp---- _-__ Distf� to nearest lot line----------------- O Number of pits-!---�--.-_______Lining materiaL___� CYSize: Diameter ------ Dept iI Cesspool: Distance from nearest welt_________________Distance from foundation---------------------Linin6 material---------------------------.___---___ Size: Diameter- ------------------- ❑ -....Depth-----_--------- ------- ----- --------------Liquid Capacity-.-.-. --------gals. ^' Priv Distance from nearest well-------------_------------------------------------Distance from nearest building ❑ Distance to nearest lot line f --,r. ---- -------------------------------------------------------------- - Remodeling and/or repairing (describe):-, �J� ._ .. ---------------------•-------------------------------- --------------------------------------------�------------------------------------------------R------------------------------------------------------------- ----------------- ------------------------------- ------ ---------------------------------------- ------------ - --------------------------- ---------------=--------------------------------------------------- -----------------`--------------------------------------.- ---------------------------------- ---------------------------------- -- ---------------------------------------------------------------------------------------------- =--------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the.work will be done in accordance with San Joaquin County ordinances, State lawaand. lesand regulations of the San Joaquin Local Health District. d�($igned) y�� Aa- --------------------------------------( or Contractor) By:------------------- ---------{Title) ------- --------- (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). r - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- { --- ----- ----- - ------ - ------ ----- DATE--------5 � REVIEWED BY ---------._ DATE-------- --------- ------------- BUILNNG PERMIT ISSUED-------------- s --------- ----- ------------------ DATE - - Alterations and/or recommendations:____ t___--. - � - � . y- --------------------------------------------------------------------------------------------------------------- -- ---------------� ------------------------------- ---------- -------------------- - ----------------------------------------------------- - -- -------------------------- ----------------------------------------------- --------------------------------------------------------------------------------------- ---------- - -------------------------------- FINAL INSPECTION BY: Date.------- 1 ' � � . _ , ter SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haieltan Ave, 4 300 West Oak Street 124 Sycamore Street 205 West 9Th Street jt Stockton,California Lodi,California Manteca,California Tracy,California