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)R CJFFICE USE:------------------------------------- ` ---------------- APPLICATION FOVSANITATION PERMIT Permit No. --------------- - ---------------------------- (Complete-in Duplicate) --.--- This Permit Expires I Year From Date Issued 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. 5494. 2rj—ff0 -V� 1 JOB ADDRESS AND LO ATIO __. 1j_ E. I _NTA__-;-'_F___,_'__ -Y. ..... Owner's NameQ-I_' ------ ----------------------------------- ----- -- Phone------------------------------------ Address.... -----•---------••--------••------------------------------ ----- Contractor's Name-- Z78A Z�3N17�S --AV1= phone----------------•------ - ----------- Installation will serve: Residence Apartment House ❑ Commercial E-] TrailerCourt ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _3.. Number of baths -_(__--- Lot size ------------------------ Water --------•--•-_-------_Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-3...__ ft. 1 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 W`�New Construction: Yes RT_'Nc ❑ FHA/VA: Yes n-_`No ❑ :TYPE-OF-lNSTAZCATION-AND SPECIFICATIONS-- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well---,5 ___-_Distance yfrom foundation----l�--------.Materia--P/� CRZ-� ------- No of compartments--------2 ---------Size--- Sde h _. /z. -__....__Capacity Zq42 .. I Y Disposal F' Distance from nearest well....5_.Q. -Distance from foundation--_10-_____-..Distance to nearest lot line----_J._______ Number of lines__-.-_.3-----------------------Length of each line r ' l g �� --Width of trench----------------y--- ------------- Type - ---- yp p . filter material------1-'7----------Total length-----------/9U--------------------- p� 7 e of filter material-_ t�_Gl�,- De th'of _.------Distance Seepage Pit: Distance to nearest well-------_.__. from foundation--------------------Distance to nearest lot line.._.______.._... ❑. Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------.------------------------- r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-...----___-._-_______-_-_--------. � �] ❑ Size: Diameter--------------------------------------Depth---------------------------------- --- -----------..Liquid Capacity---------------------------gals. �_ F Privy: Distance from nearest well---------------------------------.---------------Distance from nearest building----------_----------._______-_______--- ❑ Distance to nearest lot line ----------------------------- Remodelingand/or repairing (describe)---------------------•---------------------------------------------------------------------------------------------------------------------------------- ---- ---------------------------------------•-----------•---------------------------------------------------------------------------------- ' -- ------------------------------------------------------------------------------------------------------------------------------------------------------ ------ I hereby certify that 1 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)----'-,1 �_.._. �� -.--[Owner and/or Contractor)_. ----- -------------------------------------------(Title)-------------------- - -----------------.-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). pp FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY. fes---0----- ------------------------------------------------------ DATE----- -- REVIEREVIEWED WED BY----------------------------------- - - ---------- ------- ------------------------------------------------------------------- DATE------- BUILDINGPERMIT ISSUED------------------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------- t Alterations and/or recommendations:---------------------- -- ---------------- ------------------------------------------------•----•- ---------------------•----------- -•--------------------------------------------•----------------- -- ------------------------- ---------------------------------------------------------------------------- --------------------------------------------- ------------------•-------------------------------------------- -------- -- ---------------------------------------------------------------------------------------------------------- ------------------------------------- _____ __ _________________ __ _ ____ _____ ------------------------------_._-___--...._--_.--_...----_-_---------__.-----._.-_. p __....................... ..................... ...... .. .................... .. .... .... . -------- -_-n_.__..._'--------------`.-•------- ---------------------------------------- FINAL INSPECTI { ----. ✓ Date--- -------- - -•---�/--�-- --� ---- SAN JOAQUIN LOCAL HEALTH DISTRICT } 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ' Manteca,California Tracy,California F.RCO.