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F R OFFICE USE: 4,7 - - - --------�.210M ---- 'APPLICATION FOR SANITATION PERMITS°sem Permit No. _. �'�1. .. -------- ------ (Complete in Duplicate) — �/- Date Issued f/2-4/15 _______---__._____-,._.._.___ This Permit Expires 1 Year From Date Issued Application is hereby"rr acle to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance w' h County Ordinance No. 549. l� JOB ADDRESS AND LOCATION..._- - t�Y r r Owner's Name •✓r-_I-_--- --- -- ------------- Phone------------------------------------ Address----------_------------- 02 4(�, y - = ................................ Contractor's Name -1 ! jC_! --------------------------- -. Phone.................................. \ Installation will serve: Residence U,- partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ \� Number of living units: ---I---- Number of bedrooms Number of baths _/----- Lot size ---4�2__4� i _______________________-_ Water Supply: Public system ❑ Community system ❑ Private 04-Cre—pth to Water Table yt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q--Hardpan ❑ Previous Application Made: (If yes,date------.-------------) No �ew Construction: Yes [>.1lo ❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well-_4 ______Distance from foundation-----/f7_.�_.Ml/terial_____� ___ 49hC/ ------------ No. of compartments-------:Z---_-___---Size- _ 5 --------Liquid depth_."7�y.,,,__-___-_-__-Capacity-----p ------- Disposal,Field: Distance from nearest well_�5V__(_._Distance from foundation---/G7_:-------Distance to nearest lot line__. .-_--- Number of lines._-____�._��_-----",,__.__._p Length of each line------- of trench._ay--'_--.--_-___"-_.--._ Type of filter material-__ /j__,"- -----Depth of filter material---f_-X__---------Total length___._, .17_l--------------------------- Seepage t: Distance to nearest well--- DLJ--- ------Distance f m foundation__--l?_.f.___.Distance to nearest lot line-_,57!-_"__- 9" 4111, Number of pits----!"_"_---..-------Lining material_.A ------Size: Diameter. ---------Depth---Q_C7 _1'�!__-_ 9 Cesspool: Distance from nearest well----------------- from foundation----------------.-._.Lining material-------------------------------------- ❑ Size: Diameter------------------------------------Depth------------------------------- --------------Liquid Capacity----------------------------gals. Z Privy: Distance from nearest well------------_-----------------------_------------Distance from nearest building______________-_-.-___-__-_.-__-____-----. . ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------------------------------------- Remodelin 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, d rules and irwNlatipns of the San Joaquin Local Health.;District. �j (Signed)------------------ J �� - ------------ ----(Owner and/or Contractor) By:-------------------- - (Title)-- �-✓ - ----------- ---- --------- (Plot plan, showing size of lot cation of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - DATES / 5 REVIEWEDBY-------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------- -- _ _ -- - �_. DATE--------- ----------------------------- --------------------- _____ Alterations and/or recommendations:__ .� __� .___�'__S___,__ _ .._ ------------------ __._ C- -----------------------------------------------------------------------------------t---�--.�---�--%--�--�---_--_-.- _ l86' rf ?�O' - -----•------•--------•-- -•-•--------- - Sr L - ----- FINAL INSPECTION BY:--------------------C�'�------------ -------------- Date--- 7tl _t_6S�--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street-, 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California