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K)K Urri-t u5t: APPLICATION FOR SANITATION PERMIT Permit No. d�l.•a2-:J� ----------------------------------------------------- --- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued /_�__-.,------ Application `—Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applj tjon�made in compliance with County Ordinance No 549. /1 1 1 Z4�� !] �� ' JOB ADDRESS AND L CATION- �) -- –� f-- f Owner's --- ••--: - F' ------------------- Phone------------------------------------ Address - ------------------------------------ ------��------- --- ---- ---------- -------------------------- Contractor's Name--- �1 ' /� I'/-L-�---- -------------------------------------------------- Phone---------------------------------- - - -- ----- -- Installation will serve: Residen �Apl tment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ -_- Number of bedrooms _ _ Number of baths__XLot size ------.T`-`_.__��________________.______________- Water Supply: Public system I-] Communitysystem Private ❑ Depth to Water Table -k_-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamy Clay ❑ Adobe ❑ ardpan ❑ 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__/0dQ____-Dista e ro oundati�___ F i 1�-------- Mat ial--- _ [ No. of compartments-------�/-------------Size-- e-- q p. p Y - ti5 Li uid de th___- ------` Ca acit 6 Disp aI Field: Distance from nearest weli-/lJ.-.---.---Dfstan e from fo nd ti n____� _ . istance to nearest lot line -------- --------------------- Number -_.--_.-... Number of lines--tS ------------------___.. __Lengf�-a z ne J�:_ 5 � '-Width of french.------- Type rench _________._______ Type of filter material-�1_—nom-- �-Depth of filter material--__.� --------------Total length....... .................... \ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______________._ ❑ {dumber of pits----------------------Lining material---------------------`Size: Diameter-----------------------Depth----------------------.---------- Cesspool: Distance from nearest well_________________Distance from foundation---------------. -- Lining material_________________------ "__________ \n\ ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liqu;d Capacity-.--------------------------gals. mVJ 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- l � 1------- _ ------ ------------------- ._____-_-__._____(Owner and/o_r.-.C.ontra_.c.. r � -~ (Title)By•------------------- -- - --- -- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). C FOR DEPARTMENT USE ONLY ' ------ - ---- - -------- ---- ------ ------------- - ------ ------ DATE REVIEWEDI BY--ACCEPTED BY-----_�-------------------------------------------- ---- ---------- DATE -J - BUILDING PERMIT ISSUED------------------------------------------------------ ------------/------------- DATE---------------------------------------------------------- -- Alterations and/or recommendations------- -------- ----------------- ------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------ -------------------------------------------------------- ------------------------------------- --------------------------------------------- ------------------------------------------ . ----- ----- ---------------------- - -----------------------------------------------"--------------------------------------------------------------------------- FINAL INSPECTION BY: {� Date _��._....I.�..�-�'...�--- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.C Q.