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FOR OFVE E: r + �- ------3..--- r Ir ------------ --------_f{�,! APPLICATION FOR SANITATION PERMIT Permit Iva ------ - ----_ ------------------------------------------------ ---- (Complete in Duplicate).. .►,"" �'_ 3 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 549. , JOB ADDRESS AND LOCATION. . ------- ---------- ---- r t ------------------------------- Owner's Name-------I-,.-.--___-- -- --------------- Phone------------------------------------ // f -•____________________________________i....-___-__•-__--_---__-____....._-- Contractor's Name----------•---------------- ---------- .Y ----------------------------------------------------- Phong----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑- Other ❑ Number of living units: /----- Number of bedrooms -a. Number of baths'!-_-.,- Lot size -.__--_____________ Water• Supply: Public system 10 Community system ❑ Private ❑ Depth�to Water Table 'W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ Previous Application Made: (if yes,date----------- ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ;t (No septic tank or cesspool permitted if pu�bll�ic,esewer is available within 200 feet.) � z Septic Tank: Distance from nearest well- I/ LDistance from foundation__ D_-__.---.Material___Aa-, ------------------ ------------- �K i No. of compartments-----_ -_--- --/Size----- K�---.------Liquid depth--y---1 .----_----Capacity-----`-Q �- Disposal Field: Distance from nearest well-----I 'Distance from foundation_-/�'______.Distance�o�pearest lot line---- .... N Number of lines-----c�_________ Length of each line��__4-.___..il-4 ____.Width of trench __-C _ _ ---- __-._ N Type of filter material__cS.�_f --Depth of filter material_. _- -_.--.-Total length----------------------- Seepage Pit: Distance to nearest/well._A—,m _"-_Dist r dation___ ___.Df-to c to nearest lot line______�_�... Number of psts..t- ------ -- ----Lining mat rial- --- --:- Size: Diameter------�'- - ---___--Dept h--.-o7_+ ----•--------------- i ? Ti Cesspool: Distance from I nearest well_________________Dista ndation___._..--__-__.____.Lining material-___--_-.__.---_---__________________. ❑ Size: Diameter-------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. k Privy: Distance from nearest well.---=-______--------------------------------------Distance from nearest building__:__.___________________- ❑ Distance to nearest lot line----------------------------------------------- -------------•----••--- ----------------------------------------------------- Remodeling and/or repairing (describe)__________________________;_____. : ------------•--------------••--------------------------------`-- ----•----•-----------------------------------=------------------------------------�-------- ----------------------•:----•--------------------------------- -------------------------------------------------------------------•-------•-------- --------------------- I hereby—certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance Cafe laws, and rules nd regulations of the San Joaquin Local Health District. r (Signed)---- ---------- ------------- (owner and/or Contractor) --- - -- --- ---- - - 1 -- PA--- sy:__... --------------------- (rale) _..- - - --- --------------- (Plot plan, showing size of lot, location of system in relation to wells, 6 I dings, etc., can be placed on reverse side). F R EPA ENTXE ONLY _ F APPLICATION ACCEPT ---- r --- ---- - ---- ----- -------- DATE,- ------- --- REVIEWEDBY---------------------------------- ------ - ------------------------------ ----------------------- -------------- DATE-------------- BUILDING PERMIT ISSUED------------- ----- ✓� ----------- -- DATE Alterations and/or recommendations:----f= ��<------�� "�t `= - /- " -------------------------------•----------------------------------i--------------- -----------------------------------------•-------------------•-------------------------------•--------------- ------------------ ---------------------- -----------------•---------------------------- ----------------------------------------- --------------------.--------•-------------------------------------------- i ----------------- -----------------------------------------•--. -------- -------------•-------------------- ------------------------- ------------------- ----------------------------•----------- -------------------------- -------------- ---------------------------------------- ------ - --- --- ---------•---- --- ------ -------- --------------I--------------------------------------------------------------------------------- FINAL INSPECTION BY-- ------- ----- - --- --- ate-.../ .. SAN JO QUIN L CAL HEALTH DISTRICT 1. .1601 E.Ha:ellon Ave.: 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod'r,California Manteca,California Tracy,California Y r. ES 9 REVISED 8-59 3m -,r.3 F.P.0 C. 1 r i � y