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FOR OFFICE USE: o "� �, APPLICATIONS FOR_;,SANITATION PERMIT Permit No. .....--.----------" (Complete in Duplicate) 9 Date Issued s -"--/ ---_-----_--------------------------- This Permit Expires 1 Year From Date Issued Applicafiion is hereby made to the San Joacluin 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. .".e _�. _ ®z _ JOB ADDRESS AND OC TION..---/---�3 -------�- - ----- -- - - ------------ -'�"--- -----'----=- Owner's Name----�Q-----N-.--------- ----------------- ------------ Phone y , Address-------------- ------ --- - -- --------- - Contractors Name-----------------_-- -- - - ------ Installation cwill serve: Residence X,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1---- Number of bedrooms __Number of baths _1-____ Lot size -----_ ==1- 5 . ..------ Water Supply: Public system �< Community system ❑ Private ❑ Depth to Water Table J_'�_ ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date............. ... ") No New Construction: Yes ❑ No .FHA/VA: Yes ❑ Nd TYPE OF INSTALLATION AND SPECIFICATIONS: �1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: - g Distance from nearest well-----------------Distance from foundation___________________Material_______.._-_--._-.___--___._____---_________-.. ❑TKA-�N� No. of compartments- --- --------------------Size------==----------- ------- ---Liquid depth--------- --- - ---------Capacity----------------------- ,l ��--______.Distance to nearest lot line__- -...- Disposal Field: Distance from nearest weILN-��Distance from foundation__ _____: . Length of each line__... Q_ ------__-___.Width of trench_.. _! _______________ Number of lines,"___0-4etj__C( � g �t Type of filter materiaL��--_---Depth of filter material------ -c�---------Total length _._.____._____1-457-------'-----=- 1 " `� Distance rom f undation__ _`_ _--_ Seepage Pit:; Distance to nearest well-. _ ! ____ Di to se o nearest lot line _ may' Number of pits.&V.� Lining material__.---Size: Diameter_�w�._S-.�__4T_Dept h_-_�.!t - Cesspook Distance from nearest well-----------------Distance from foundation------------------ Lining material-_._.-.--.--.___- _____.____-___9_ I F1 Size: Diameter----- ---- --------------------------Depth- ------------- A----------------- -----------Liquid Capacity- ------------------ gals. Privy: Distance from nearest well------------ ------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line --------------------------------------------- --- -----------•-------------------------------------------------- ----------------- Remodelin9 and or repairing (describe ----- -- ------- ----------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- l I hereby certify that ve prepared this application and that the work will be done in actordence with San Joaquin County ordinances, State I and ru es nd regulations of the San Joaquin Local Health District. (Signed)------------------ -- Q' LS.yTi� -4.. d N _Owner and or Contractor 6 .................. - - ----------(Title)...... - -------- ---------- By: •--=------------ -• _ I� (Plot plan, showing size of lot-jocation of system in relation to wells, buildings, etc., can be placed on reverse side). I F R DEPARTMENT USE ONLY ----- - DATE----- ---1 = APPLICATION ACCEPTED BY____._.---.- --------- REVIEWED BY---- - DATE--------------- --------------------------------------------- - -------- - -- ---- --------• --------- --------- tBUILDING PERMIT ISSUED--------------------------------------------------------------- _----------- --------- DATE_ - � Alterations/JandZ"i ecommendations:2-Y1'7__._ .6F fr_ ---------fy I Fr��h` - �`•r yFrlL----- /� rsf'�'©/bf�l'a7r J G+ �/ ' --------- :- '1-------------- -- ------' ' ------- ---------- ------------- --jr -�._.". 004 FINAL INSPECTION BY:. '. . Date __,2/,6*------------------- - ---------------------------------- SAN -------------------- ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasefton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Californi&'y,"-'4,. Manteca,California Tracy,California