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F R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 4 A / ---------- (ComplhR., •n�Ouplicate) �( � ------------------------------- - 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 in5tall the work here-"—described. This application is made in compliance with County Ordinahce'No. 549_ 14. /lgLbyOCA` TION'JOB ADDRFSSI`AN , f _ oneOwners Name----------- --------•--------- i --------------------------- A A ---Address-----=-- -- ----- --- ------ - �Contractor's Name CiR' r Phone�`.� Z—Zllp O Installation will serve: Residence E] Wpartment use ❑ Comm tial ❑ Trailer Court Motel ❑ Other ❑ Number ofg units: �____ Number of bedrooms ________ Number of .baths ________ Lot size __________-________________________________________________ Water Supply: Public system' Community system ❑ Private�pth to Water Table ______-_ ft. � ' Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam R C—<ay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made:' (If yes,date---:----------------) No W--<ew 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.) • foundation . � -- Septic Tank: Distance from nearest well --Distance from _-______________---Mate ial_-_ i?h�/j _______________ - ________ ❑ r No. of compartments---- Size---------------•----------------Liquid depth---`yS --.--------:Capacity_16-mc�2'{ - o Disposal Field: Distance from nearest-well-6-6 `f- Distance from foundation #-D---_ ---Distance to nearest lot line----------------- .. ❑ Number of lines. -- Length of each line___/__fr�,Cz_____ _____ _'Width of trench,-' ___ -"- Type of filter material_1 '__ ____________Depth.of filter material- _. ____________Total length----_...----_____ ____:t=o_ Seepage Pit: Y—Distance to=neardst""411---------- from'found-ation___-_- __Q__...__.Dista ce to nearest lot line-�=-_--_-._ -jj ❑ �' Number of pits-- _ -.-----__--Lining material__________- - Size: Diameter' - Depth -_--. Cesspool: •.Distance from nearest well_`_____:�_____Distance'from foundation__ ______ _____'--_.L ing material___-_______________-___-____________ Size: Diameter----------------------=--------- De t� ----------------------------- - -----------Li Liquid Capacity❑ i 9 P tY ---------gals. Privy: ,� i. Distance from nearest well--------__--,_____________________ _ Distance from nearest building --------------------------•------- --: ❑ Distance to nearest lot line--------- -----------------------------------------------------------•----I-----------------------=------------------------------------------- Y + K. . 7 Remodeling and/or repairing (describe)'-----..- --- :_-----=------------- -`----------------•------------•---------------------------------------------------------------:-------------------- _ ---------- ------------------------------------------------------------------------------------------------------- ----'---------------- -••-------------------------- --•-------------- ----------- ---- •------------------•-------------------------=•----------------------------•--___-•-------------------------�----- =: ----------- ------------=----------`----------- ------------------------------------------------------------------------------------------------------------y 3 1 hereby certifylthet I�have-prepared this application.and that the work will be done in accordance with San Joaquin County ' ordinances tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed.,- - ---- ---------------- ' - - - � '---------- ,--- -----=y------------------------------------------ ---(Owner and/or on ractor _, By: t - ---------------------------------------------•----(Title ---------- -- plan, showing size of t location of syste- in relation to`wells, buildings, etc., can be placed on reverse si e). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- --- ----"-_-- -- _-- - DATE----------- --- __-- -- " REVIEWED BY - ---------------------------------- DATE------ --- /" -7--------- BUILDINGPERMIT ISSUED----------------- ---- --- ---------------------------- - -------------=------'- =` DATE--------------------------------------------- --------- Alterations and/or recommendations` ` a • ____"_ l ---------------------- n� ---- *--I- , - � �•-_- __ _ _________ __________________________�--_____-__-L _ 5 . f4 }- -------- ... -a,�_ mow,-•1-� - ��L$ J Date �l � --- - - FINAL INSPECTION BY:------ =---:----- -- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California r Manteca,California Tracy,California ES 9 REVISED 6-S9 3M 3•'63 V.F-40-