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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) - Date Issued __-_xf Application is hereby made to the San Joaquin Local Health District for a perrnit.to construct�add in all the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --�-a__ ------------- ------------------------------------------------------------------------------ Owner's Name__ �'a- -I-t-k1----------------- ------------------------- ----------------.. Phone-------------------------------•--- / r Address------------ -- 1�- 'J l Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l____ Number of bedrooms __j___ Number of baths __1___ Lot size ---��Q---X___SZ-0.4----------------------- I Water Supply: Public system Community systemF ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E� No New Construction: Yesj!;_,Na ❑ FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ddII Septic Tank: Distance from nearest we1pTi(-pistanc from foundation__jf ....... .Material__ L \ No. of com artments_._ _____Size__ yy ,/ t [,� p �--- - -.'J ,/i--�--�_�Liquid depth------/- ----------Capacity---��--- - ' Disposal Field: Distance from nearest wellwgw-.._____Distance from foundation___.__._____Distance to nearest lot line----=____- Number of lines------- Length of each line____ C� 9 C��----el Width of trench-o? j------------------------- ' Type of filter material-_ Depth of filter material__ ________________Total length--- ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation.................-..Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------------- - , Cesspool: Distance from nearest well-----------------Distance from foundation__.'____:_-_.-----Lining material-____-______________________________ ❑ Size: Diameter--------------------------------------De th_=_ - --------------------__ -Li Liquid Capacity # - - ------ q -- - - -----------------gals. Privy: Distance from nearest well'_"--.-------------- ---------------------------Distance from nearest building-----------------------------------------. i ❑ Distance to nearest lot line_.------------y l Remodeling and/or repairing (describe)------------------------------ --------- -------•--------------------------------- ---------------------------------------------------------------- --------------------------------------------:-------------------- --------------------------------•------------------------•------------------•------------------------------ I 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. t Sign ---------Q,aen.� 1, _________________________(Owner and/or Contractor) =� By:.- -�R- -----•----- _•L .�----------------------------------------------------------(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---- ----- - ---- ----- --- ---- ----- -------------------------------------------------------- DATE �-- lEVIEWED BY--------------------------------------- ---- -- - -- --- - ------------------------------------------ DATE z i. BUILDING PERMIT ISSUED_____________________ __ ___..._ DATE_.__ _-- _Y ____ _______________ ________________ --_ ._. __ - _________ ________ y Alterati ns-and/ recommendations:__- _-- - -_._ _ _ -4 .. C ___ = � _-- .fir, _-.- = ter. {- f � P—* a- { ------ ------- --•- ----------------------------------- FINALINSPECTION BY------------------------------------------------------------- Date"-- --„ ,_---- -------------------- - ---------------------=-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT .130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO.