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FOR OFFICE USE: -C -6 �� -- /' o - -------------------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) ---- ----------------------------------------------------------- Date Issued 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 Ordinance No. 54q. JOB ADDRESS AND OCATION..___6;?//7/ - -------------------------------------------------------------------------------- Owner's Name. jr � - -------------- 4-- ---- ------------ Phone------------------------------------ Address ---------------------------- Address-----•------------------------ --- ----- ---- -- -- ----------------------------- ----- - ------ -Contractor's Name- ---- --•-- I Phone7OZ�2/5 / Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑ Other ❑ Number of living units: -C:;?— Number of bedrooms __r,2-_ Number of baths ________ Lot size ----------------11 Water Supply: Public system �Communify system ❑ Private;1-Depth to Water Table _`�?�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date..------------------) No ❑ New Construction: Yes ❑ No 9,- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is available within 200.feet.) Septic T9nk: Distance from nearest well-.2 Distance from foundation_�Q-. ateriai n ` No. of compartments Size--- =_ _ -Liquid de th._..>-1-_-.-. ---_ _-Capacity dlJ_ RX/ P --- - �-- -- - q � P. 7 - - P Y--- � Disposal ield: Distance from nearest wel9- ___�-Distance from foundation,/,_._-, 1Distance to nearest lot lineerS----------- Number of lines.,__.-�___ -Length of each line--_--_____4!Q.`_.__..._.Width of trench.__-. ��................... ! / ".i Type of filter material____._._ _. epth of filter material___�_,�._ .___.Total length---------------�-�_�___--------- ____.. Seepag it: Distance to nearest well-.?Zc014Q--__Distant f ndation_,/Q._,, -,stance to nearest lot ------ IR Number of pits---_ - -_._ .. . -. ----Lining Size: Diameter----3 ... _...Depth------zzZ_-S`_-_---_---__- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------°---_-._-_._--.- [) Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity -----gals. Privy: Distance from nearest well-------------_------------------------------------Distance from nearest building----------_-------'-J_---..----.._--. ❑ Distance to nearest lot line-------- ------ --- ---- --- ---- - - ------ - -----------------••-------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------- ------------------------------•-------------------------------- - - ---l---�-,---'------------------- ------------------------ •--------- 4------- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will Fie done in accordance with San Joaquin County ordinances, Ste laws, and rules7 and r gulations of the Sa Joaquin Local Health District. (Signed) ----------------------------- ---- - - Owner and/or Contractor B - ------- ------ ------------------------- ------------ Title � _. �L� }` (Plot plan, showing size of lot, location of system in relatt o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •------------------- ---------------------------------------- DATE---------------- _ ----------- REVIEWEDBY----------------------------------------- ----------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------ --- / � DATE Alterations and/or recommendations:_-_._-__�. 1` _.__ . ______ ----------------------- ----- ----------------•------- ------------------------------------------------------------------------ ---- -------------- --- ------ --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ----- ----- ----------------------------------------- ------------ -------------- ------------------------------------------------------------------- F1NAL INSPECTION BY: '.. ------------------------------ Date-----------7"p-6. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.CC.