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FOR OFFICE USE: - ------- ---- ----- -- -- _ -- ------ - APPLICATION FOR SANITATION PERMIT Permit No. .�__. j- .�_.. (Complete in Duplicate)II ,,�Date issued _ lU___1, f From Date Issued --..-__ ._-- This Permit Expires 1_Ysar„F , Application is hereby made to the San Joaquin Local Heal#Dict r per it to construct and install the work herein described. This applicati' oriis made in compliant ty Or ina9 M"rV� QF----� o � ,�-_------------- JOB ADDRESS AND LOC TO ________k -�__”__U_ _____ ____ ___ _��i,_.____ ' ' Owner's Name--------------- ------- -URNE--_�--•------ ------ --------- ---------------------------------_---- Phone----------------:------------------ Address....................•- •------ 77 4 ` Contractor's Name-.CAR61A--�---------------------------------------------- ------------------ -------------------•------- ---------------- Phone.----------_-__ ---------------- Installation will serve: Residence en'Apartment House ❑ Commercial E] Trailer Court [I Motel [-] Other ❑ Number of living units: __J____ Number of bedrooms _Z__ Number of baths J--- Lot size _197'r-K"-OF____^___________________ Water Supply: Public system E] Community system ❑ Private �'Depth to Water Table _-0 ft. Character of soil to a depth i f 3 feet: Sand [Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2`_ New Construction: Yes ❑ No 1&' FHA/VA: Yes ❑ No i� TYPE OF INSTALLATION AND SPECIFICATIONS: j A -°- '7 No-se fic tank-or cesspool ermitted,if-public-sewer-is available-within 200 feet. - Septic Tank: Distanceo. oicojrom nearest well___.�0.____Distance from foundation__._fV_._____-Material____COWC�iaT'�.___..__. Ikmpartments____--2 ------------Size--' _ / --X_- _--Liquid depth---- --.--------Capacity--J-" __. Disposal Field: Distance;from nearest well__..,50_._Distance from foundation____-A9........Distance to nearest lot line...... Num of f f lines---------- .._Length of each line-------- __ Width of french._.___.�k_'r Type filter material__,R__C?«-<,___Depth of filter materiaE___17_ --__ --Total length------------ Seepage Pit: Distance &o nearest well-------_----_---------Distance from foundation--------------------Distance to nearest lot line------------------ 0 _-___-- _--__-❑ Number of pits---------------------Lining material----------.------------Size: Diameter-----------------------Depth....__.--------------------------- Cesspool: Distance!�from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------- ------gals. : I (A a Privy: Distancefrom nearest well__________________.____._..---------------------Distance from nearest building.__._.____.___________ ❑ u ,____- Distance l�,to nearest lot line---------------------------------------------- -----------------•--------------------------------------------------------- ------------------------ -------- ----t i Remodeling and/or repairingll (describe):------------------------------------- o ; - ---------------------------------- --------------------------------------•---------•---•---•----------------------•--------------------------------------------------------- -,'- ----------- ---- y - li` 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 r'iu s,and regulation of the San Joaquin Local Health District, .? {Signed) (Owner and/or 'Contractor) (Plot plan, _ -__:__ _ = (Title) -_ F - = ------ (Plot showing size of lo#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____-_-- ,C -.-------- -------- _ ------------------- -- - - DATE_ --�� "_�-�--- -=--------- --------- REVIEWEDBY------------------------ --------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--I1------------------------------------ -------------------------------------------------------------- DATE------------------------------------------- -------------- -- Alterations and/or recommendations:------ - -- - - ----------------- ------ - --------------------------------------------=--------------------------------•-----------=------------------- N 1 Il 'll. ---------------- --- ------- ---- - - - - -•' "--------•- ------ ---------------------------------- ------- ---------- --------•- ----------- -------------------------- . it ; FINAL INSPECTION BY:.. .. ----------- ------ ---------------------------------------- ------------- -P - ----------- ------------------- ------------------------------------- ------------------------------------- �� . 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 F.P.r Q.