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FOR OFFICE USE: _----------_ _ APPLICATION FOR SANITATION PERMI S sNo• ,f�Q............. ---------------- ------------------------------------- (Complete in Duplicate) K --------------------------- ------------------------ ---- IThis 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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS.AND LOCATION j/ Q ------ -- - -----------------------------------------------------------------------------/---'--,-----------------pp j Owner's Name `-----{{ ----------•------------------------------------------------------------------------------------ Phone<f--_3.... Address-------- ------------------------------------------------------------------ Y Contractor's Name------. -----------------------7--5----------------------------------------------- -------------------------- ------ Phone................................... Installation will serve: Residence []4partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t---- Number of bedrooms___- Number of baths _.j____ Lot size __-- -------------•_----...__ Water Supply: Public system ❑ Community system ❑ Private [7-Depth to Water Table _Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [} Iardpan ❑ Previous Application Made: (If yes,date--------- ----------) No [l]'� New Construction: Yes 29"No ❑ FHA/VA: Yes ❑ No P�-' 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-IAA-------Distance from foundation-- _...._..._ ..Material__ -h ____________________ No. of compartments..- ----------.__.__Size._3.x.S=y._`7.........Liquid depth------- _--------------Capacity....kA8-- _. Disposal Field: Distance from nearest well-l-oQ.__-----Distance from foundation..A4.- ---------Distance to nearest lot line----.:_..__.�__. [ - Number of lines--------2—---------------------Length of each line._,jvtt_-_c ---------Width of trench.._.A_,r____________________ Type of filter materia.___yt--o.S. --_--Depth of filter material-/-.k-__`-----------Total length-----/0-A_'_____________________ Seepage Pit: Distance to nearest well__/va__'--------Distance from foundation_> ------------- istance to nearest lot line--k------------ ,;:24 d [f Number of pits-__R --._..___.._Lining material____`.//�-_tit --Size: Diameter-_OL3...``._.-__-Depth----- ��---.-_...._-_. 0 0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_---------------------------------- .) ❑ Size: Diameter----- --------------- ----------------Depth----------------------------------------- ----------Liquid Capacity------------------------_--gals. Privy: Distance from nearest well _____________________-______-..-__---......._Distance from nearest building--__---____-._______________------_-_._. ❑ Distance to nearest lot line------------------------------------------ -- ------------------------------------------------------------------------•---------------------- 9 Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------- --------------------------------------------------------------------------------------------------------------------------•-------------------------------------------•------------------------•----- -------------------------------------------- -------------•------------------------------•----------------------------------------------------------------------------------•---------------- ---------- ------ I hereby certify at I have pr are this application and that the work will be done in accordance with San Joaquin County ordinances, State la , gqd rules d gulati s of the San Joaquin Local Health District. (Signed)------- �___ ---------------- ------------- --------------- -------- ----------------------------------.(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)------------------- -------- ----------------- -.-..--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -----------------------------------•----------------------------------------- DATE------- ---------------------- REVIEWEDBY------ -------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------ ---------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------- .-•- Alterations ancUor recom endtions: ----------- -------------- ----------------------------- - - - -- - ` -}�------------- ------------ ,ee ,ems-- �' _-- ' -------------------------------------------- ------------------------------------------------------------ - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--------< ------------------------ ---------------- Date------C77-?7 6�------------- ------------------------------ 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 F.F.0 C.