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FOR OFFICE USE: ,� 3 APPLICATION FOR SANITATION PERMIT Permit No. .. ................... ----- ------------------- ----------------------------- (Complete in Duplicate) Issued --••---••---�- --.. . ---------------------------------------------------.- . I This Permit Expires 1 Year From DateIssuedDate Application is hereby made to the San Joaquin Local Health District for a permit to construinstall the work herein described. This application is made in compliance with County Ordinance No. 544. J08 ADDRESS AND LOCA71 [ - —��---------------••----- Owner's Name------------------ •Ft',"p A� ------ Phone ---------------------------------- Address...................... `-----. I------ �--------------•-.l�b ------------------------------------........................................ Contractor's Name-------- 41L --• •--- - -• - ------------ -------•----------------------- ..........I--------------_-------------- Phone................................... Installation will serve: Residence 2] 04" I House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __� Number of bedrooms _'-_. Number of baths Z'___ Lot size ______________ ___ _____ Water Supply: Public system ❑ Community system ❑ Private ® Depth To Water Table _2r ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ® New Construction: Yes 90 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 we4��v Distanr�e from'fou dation__-_�O_.----__.Ma erid l.. _...f� �----ice t _. y �r No. of compartments------- - ----------'----Size- __L t_ "f----- ---Liquid depth----- --------------------Capacity_.._-:-------------'GJ Disposal Field: Distance from nearest well_4.7e .,_Distance from foundation.,Zo----------..Distance to nearest lot Number of lines___•2:__.. {____ ength of each line..--J'p-------------------Width of trench-_.2 - Type of filter materia ' --_. Depth of filter material--__/r _�_______-Total length-__= __(G: _�__________________________ .�,. 11--1-_Dl Stance from foundation--------------_____.Distance to nearest lot line--_------------ Seepage Pit: Distance to nearest well----------------- ❑ Number of pits'----- -----------_Lining material------------------!--Size: Diameter------.----------------Depth----.--.-------_---_-------- IL t est Cesspool: Distance from nearwell__________-_-_-_Distance from foundation--------------------Lining material----------------------------.---_____ ❑ Size: Diameter------------------=------------------Depth-------------------------------- ------------------- Capacity-------------- -------------gals. Privy: Distance from nearest weiL__.______________________________--- _--------'Distance from nearest building----------------------------------------- . ❑ Distance to nearest lot line------------------------ -------------------------------------------•---...-------•-•----------•--------•-----------•---------------------- Remodeling and/or repairing (describe):-------- yZt� -------------------------------------------------------- ---------- -1 ----- ------------••-------------------------- � ` ' - '� --------•------------•--------------------------------------------..--------------------------------- ____________________________________________________•____----_______________-____-...______--________--_-----_______-__________._______-•-_______.--_____----________-_-___________-___________.__._____-______- 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) - -------------------------------------- ------.(Owner and/or Contractor) By:. _------••�`--= = r (Title}--------------------------'--- - .. .......... (Plot plan, showing size of lot, ocation of system in relation to we Is, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY---- --------------------------------------------- ----------- DATE. _'�,. Al REVIEWEDBY-----------------------------------------------------------------------------------------------------•----------------------•- DATE-------------------------------------------------- ----•--- - BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- ------ DATE----------------------------------------------z-i--------- .1�3 Alterations and/or recommendations--------.----------------------------- •-••-•-------------3_9----------- ------------------------------•----------•-------•-----------------------•---•-----••--•----------- ------ --------------------------------------- ----------------------------- ----------------------------- ----- ----------•------------•--------- - --------- Date--- FINAL INSPECTION BY:------ - �.` ' SAN JOAQUIN LOCAL HEALTH DISTRICT f !fib 130 South American Street 300 West Oak street 124 Sycamore Street 205 Wast 9th StreetD Stockton,California Lodi,California Manteca,California Tracyr California f3 E5 9 RBVI5ED 8-59 2M 5-62 ATLAS 7