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I-UK UFFICE USE: - "'•�' �^�_ � � =ba; ------------------------------------------------_-------- APPLICATION FOR SANITATION PERMIT Permit No. 11 ----------- ---------------------------------- ----- (Complete`in Duplicate) ------------------- 'This Permit Expires 1 Year From Date Issued Date Issued .__1_�� 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. 549. Y JOB ADDRESS AND LOCATIONA/f Z,6-------- J_ -- ---------------••-------------------------------------- --••------------------------- Owner's Name_----- / _F�i�r---------------------------------------------------- ------=�----• ------ ------- -------- - -- Phone------------------------------------ Address----------- - -----------=-------------•-------------------••---------------------------------••--------------------- --------------------------------------------- Contractor's Name_.___ :__----• •-c��Cc ---------------------- -----------------. Phone----------------------------------- Installation will serve Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J__ - Number of bedrooms ---I---- Number of baths _1r Lot size Water Supply: Public system �9\ Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r4+ Hardpan El 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 -____ _____Distance from foundation_. D__------_-.Material_..1 -1------NL No. of compartments---------- -----------Size------ 5'7C-_7-----:___Liquid depth-_��_ r-------..-_Capacity------C? _7�/ r Disposal Field: Distance from nearest well------7......Distance from foundation----/P-_..___._-Distance to nearest lot I�ne___ _____._. Number of fines---.__J---------------------Length of each line-------4�f�___-----------Width of trench. J- - J ' Type of filter material_RpC__e_ ---.-Depth of filter material----e c ..'.__...._Total length___-___.3`6_T__ Seepage Pit: Distance to nearest well----------------------Distance from foundation___________-____._.Distance to nearest lot line_________________ .. ❑ Number of pits----------------------Lining material-------------.---------Size: Diameter-----------------------Depth__-------------- >G Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__-.--------------------------------- F1 __---___._____- ____-______-❑ Size: Diameter---------------------------- ---------Depth----------------------------------------------------Liquid Capacity--- ---------------gals. ; Privy: Distance from nearest well--1__________________-_-_- _-----Distance from nearest building . ❑ Distance to nearest lot line------------------------- ----------------------------------------------- Remodeling and/or repairing (describe:__ -__E .p--tc.c �� ,� �� _ • 2_ — -—------ -��.�_�- �. ------------------ -- --------------- -------- ---- ---------------------- ------------------------ ----------- -------- ------------------------------------------------------------------ --------------------------------------------------------------------------------- - -- - - ---- - - ! 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 tines and regulations of the San Joaquin Local Health District. - rr (Signed)--' ---------------------------------- ----------- --------------------- --------------------------------------------)Owner and/or Contractor) $Y= ------ -- - - ----Y--(Title)---------- -------------------- -------....------ ------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ REVIEWED BY ---- __ DATE__/—_;T-6= ' 6� -------------- ----- -------------------- ------------- ------ DATEq BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE. Alterations and/or recommendations:__f?-�/P�-___- -----------�'------- ..__. G - ------ --- ------ ------ -------------------- ----------- ---------------------------- ----------- ------------------- --------- -------------------------------- k FINAL - FINAL fNSPECTION BY------------- -------------------------------------------- Date---------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California _ Manteca,California Tracy,California F.P.0 µ