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: - _.-___ .__.r - ----_� ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ----- -------------- = --------------- (Complete in Duplicate) ------------------ ---- This Permit Expires 1 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. 549. JOB ADDRESS AND LOCATION �7.- s� s •S�" ------ y , Owner's Name C/ i�_/! t( � tom ' --------------------- ---- Phor _ Address----------•-------------•---- .- ------------------------------------------------------------------------------------------ Contractor's Name__ _ - ____ �partmnt Installation will serve: Residence ouse ❑ Commercial ❑ Trailer Court ❑ Motel [j Other ❑ y Number of living units. I------ Number of bedrooms - Number of bat __2e_-__'Lof size ___-_ --> 5.�----------•--_-------- y Water Supply: Public.system ❑ Community system E] Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam ❑ Clay Loam ❑ Clay ❑ A ardpan ❑_' !h mow. Previous Application Made: (If yes,date-_-- ._____:.) No E] -New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) S cParn Distance from nearest well------.._..------Distance from foundation-------------------Material __.-_.____._..__.._._-.-__.__________...___._:. No. of compartments-------------------- ---Size--------------------------------Liquid depth------------- ------------Capacity-----.- ---------------- i a it Distance from nearest well.. -Drstance from foundation----/=57_._-Distance to nearest lot line_________ 1 Number of fines__________ __ _____ _ ength of each line_____ Width of trench--e ''�-----____ d Type of filter mat eri epth of Cfer material____.___. _ Total lengfih_________ _________7�--- c /I Seepage Pit: Distance to nearest well.________ _Distance from foundation--------------------Distance to nearest lot line_____.____.______ ❑ Number of pits----------------------Lini material-------------------....Size: Diameter.----------------------Depth-----------------------___-_ ---_ d Cesspool: Distance from nearest well______._:_...__Distance from foundation---------- --------Lining material_-------------------------------- ❑ Srze : Diameter------- ----------- - ----Depth-------------------------- -------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well-------__--------------------------------------Distance from nearest building-------------.--------_________.____.._. ❑ Distance to nearest lot Gne--- ------------------------------ -------------------------•- ----------------------------------- --------------------------- Remodeling and/or repairing (describe)-------------- -------------------- - -----•--------• ----------- - 1 1 ----------------------- --------------------------------------- ----------- --------.------.-j.-------..-----.-------------L------------------------------------------------------ -------------------------- ----------------------------------------------- ----------------------------- I hereby certify that I have prepared this application and that the work will.be don in accordance with San Joaquin County ordinances, State laws, Id rules and regulations ofjrelafi n Joaqui Local Health District. (Signed)..--- �/J�� ---- r. ------------------ -------------- Contractor) SEPTIC TANK S RVI .€ By 2915_E_Ntirr�v/kin-:---- Q-G?- 1-------------------- ---- - ----------- ------ (Title) [Plot plan, showing size of lot, location of system in to wells, buildings, f7c nbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- --------------------- ------------------------------------------------------------ DATE--------------- REVIEWEDBY---------------------------------------------------------- --------------------- -------------- --. DATE BUILDING PERMIT ISSUED Alterations and/or recommendations: -------------------- -----------------------•-----------------------•---------------------------------------- -----------•------- --------------------------I------------------------------------ ---------------------- ----------- ------- •----- --------------------------------------------------------------------------------------------------------- ---------------- ---------------------- - -- ---------------------------------------- - ----------------•------------------------------ -------------------------------- ------------ ----------------------- ----- � , /�� FINALINSPECTION BY:----- �-'-- .. Date--------------- ---- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California r.P.Co.