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FOROFFICE USE: 3 � --------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ..� ----------------------------- --------------------------- v (Complete in Duplicate) Date Issued ._r - -- � -- This Permit Expires 1 Year From 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 Ordinanc-e.N-o.,5449. JOB ADDRESS AND LOCATION d/ i �� Q = Tf G .•� 4, Owner's Name (---------IK Phonl_ . ............. Address------------------------------------------------ _/._ ,.�.5£ Contractor's Name----P-A---&__iR-1-5-- -----------A------------ ----------------•-------•• ---------------- Phone_14:1?_&._'r'__Z__ Installation will serve: Residence) Aparfinent House ❑ Commercial ❑ Trailer f Motel ❑ Other ❑ Number of living units: '.Number of bedrooms __ _ Number of baths .!------ Lot size __t—-------aA�q:�- Water Supply: Public system ❑ ,Community system ❑ Private K, Depth to Water Table -767ft. Character of soil to a depth of 3 feet: Sand E] Gpvel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeN Hardpan ❑ Previous Application Made: (If yes,date-----------,-------- 1 -No { `-.New Construction: Yes ❑ No [�` FHA/VA: Yes ❑ No/q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feet.)„,,�,e �-•-- # 1--------------Material-.- - -------• Septic Tank: Distance from nearest well___------Distance fr foundation_._. FSC _ No_ of compartments____Z'---------------Size__1_?�_�� -----------Liquid depth___577-------------- .. Disposal Field: D•stance from nearest well..A ....._Distance fromoundation---9�6___--___yDistance to nearest lot line_______.._.. Number oftlines__T - __ f� Length ofeatli line��•_��_-__ _ 7/) Width of trench____ . _`------------------ Type of filter materia!___ t5i r1 .....Depth filter material___.. _ ____.__._Total length_.------ __f---------------2�_!= _ Seepage pit: Distance to nearest well---------0 -- ance from foundation_-''R'�-----------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining matei'iial----------------------.Size: Diameter_'----------- --''-Depth----------------------- Cesspool: Distance from nearest min.__ __ei-_-. Lininn aterial_._________________________________-.f , tm F-1 Size: Diameter -------------------------N _ D` e t _ Liquid Capacity gals. Privy: Distance from nearest,wll--____________________.____________------------D}stance from nearest building.._._...____________.____________._____- ❑ Distance to nearest lot h"nr~--------------__, 01 Remodeling and/or repairing (describe):_ _ --------------- t--------------------------------------- ---------------------------------------------------------------- r � w 1 t _ ------Z - __� ............._.............................................._____________J(Y___._____ _ ___ _ _______________------------------------------------------------------------------------___---.----------_----lE------ ._ I hereby certify thaf,l-"a a prepared fhis'application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and�rulis and regulations of-,the San Joagkiin Eckel Health District. E "'`! _y._ ! f -�``__ Owner and/or Contractor (Signed) --- -- , - ,. - -:._..- -------- --------------�---I / } -- --- --- - - ( } r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______ _ _ ________ ---- ------- ..._..-.. _ __ DATE________3__`_ _6. - -------------- - ----------------------------- REVIEVIt@, BY---------------------------------{---------- ---------------------------------- --------------- ----------------------------- DATE-------- -----------------------------------------# BUILDING PERMIT ISSUED I DATE------------------------------------------------- I ------- ------------- - - - ----- - Alterations and/or recommendations----------- --------------------------------------------------------------•=--------------------••----•-----"` ------- -----= ---------------- ------------ ---- --------- -------- ” - ----- ----------- --- ----------- - ` = = -st_:r ._c :cr~ .. r t r --------- ------------------------------------- ------------------------------------------------------------------------ ---------- ----------------------------------------------- ---------------------------------- FINAL INSPECTION BY:... �'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 o F l