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FOR OFFICE USE: ` 4 1 '5'7 37 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. Q`..6�..s n... --- --------------------------------------------- (Complete in Duplicate) •+ Data Issued _/__ =_ _-'1 _ l a _ 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 complianc wioth�C nt}�Or 'na el NQ_S49�. JOB ADDRESS AND LOCATION__ +4ju-- �L� #~-'?`� �r,.. ------------------------------- Owner's Name------ -------------------------------------------------------------- ----------------------- - Phone--------------------------------•--- Address-----•--..... ........ .......,. ------ l y-------------------- ----------------- - Contractor`s Name_ �t------------------------------------------•-•--•-•-----_-_ Phone --------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑�lMotel ❑ Other ❑ Number of living units: 1______ Number of bedrooms _14___ Number of baths'____ Lot size _ 6 't ______________________________ Water Supply: Public system ❑ Community system ❑ Private,ja Depth to Water Table Y-X_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_..___.._____---_.) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ 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-----Is_p_'__ Distance f�m foundation---- �__ _ Material___-- --- t'^ __________________________ No. of compartments----)------------ Size__t�._�-�_._IF--------Liquid depth-----q-----------------Capacity-?-fir_----------- Disposal Field: Distance from nearest well -6-A _--_.-Distance from foundation-----6 6_'_______.Distance to nearest lot line----S--------- 29 ___S_-____--- 29 Number of lines------/---------------------------Length of each line___._-a"---__-Y"_-'-_.Width of trench--P-_Z/.M___________ ________ w Type of filter material�___t?_W_a---.Depth of filter material------j_;F----------Total length---/_&-_T-'____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-__.___________ ❑ Number of pits----------------------Lining material----------_------------Size: Diameter-----------------------Depth--------------------------------- 00 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 ❑ Size: Diameter--------- -------- -------- - -- ----Depth---------------------------------------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well-.---- _______________________________Distance from nearest building---------------------------------------- ElDistance to nearest lot lire---------------------------- ----------------- --•---------------------•-------------- ---------------------- -------------------------------- �4 Remodeling and/or repairing [describe= L'[, �-- �3;� --------------------------------------•-------------------------------------------------- --------------------------------------------------------------- ----- ---------- -------- ---------------------------------- r• --------------- --------------------------------------------------------------------------------------------------------------- - - (b ------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ , 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)----- ------ ------ "C--{-- -- --- --------- - -------(Owner and/or Contractor) BY: ------------------------(Title) (Plotplan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--A � ---------------- ----------- DATE-- ! 3 -- - -- -- ---------------- ---------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------ -------------•---- ---------------------------------- BUILDING PERMIT ISSUED------------------------------------------ ---------------------------------------------------------- DATE------------------------------ -- --------------------------- Alterations and/or recommendations------------------ ------------------- -------------------------------------------------------------------------------------------- -------------------------- ----- --- --- ---------- ------------------------------------------------ --------------- --------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------ •--•----------- ------------------------ ---------•------------------------------------------------------------------------------------------------------------------------------ ---- -------------------------------- FINAL INSPECTION BYt ------- -------------------- Date-/l-f -". --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.