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......____. -------_._--------- AFuCATION FOR SANITATION PERN,,,,i Permit No. ,. - (Complete in Duplicate) ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued ..... _�:-. . S Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. tGf�� r JOB ADDRESS AND LOCATION_.. ... _----------- ------ Owner's Name--------- . -.._�!' _------- C pp � pp il�'yr2�fc�nn Phone..--------------............ . � Contractor's Name..._ ._y��! _ZIP-:'!i°U.:1-c.::LG--£�- ,---------�2-`Z.�.�--�.��one--------------------------------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-.-- Number of bedrooms 27_. Number of baths Lot size ---�1°sl�.___, --- ------------------------------ se ._--.-__------.___----- see Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table4Zrft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam Clay ❑ Adobe ❑ HardpanA Net Previous Application Made: (If yes,date I No Pp New Construction: Yes M No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) hes Septic Tank: Distance from nearest well.---r -'----Distance from foundation---i%?'-------.Material--- --'--------------- c4f No. of compartments.__------------------Size-3.1..'_±_.s.`z-...._..Liquid depth.-.-y----------------Capacity.4? -._.-....- D' al Field: Distance from nearest well.z-Q.'.......:Distance from foundation..--}0---------Distance to nearest lot line S 1 _.�► seeNumber of lines._--�c--..-..-.-..__.-_.__..Length of each line.....1.4r0_----_._._-.-.Width of trench----- .......-...----- Type of filter materia f. �' y e?Ppr�f..Dopth of filter mafienal_....1 -------Total length_...a'1.-.1f.1!_.'.------_._..___. � 2 Seepage Pit: Distance to neares# w3 _-...._----.-._..._Distance from foundation..................Distance to nearest lot line.-..-.-.-____ i� Number of pits--------------------Lining material..--_._-_-.-.--.--...Size: Diameter._...-...------.-.--.Depth._..__....._._-.--__--.-._. Cesspool• Distance from nearest well---------------.Distance from foundation--------------.--.Lining material-----------.---------- ...__-.._... ❑ Size: Diameter.----------------------------------Depth---------------------'-------------------.._Liquid Capacity---------------------------gals. r .. Privy: Distance from nearest well------------.----------------------------------Distance from nearest building_________________.______.-..-....-.....-. A ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------...-------'--------`------------------- Remodeling and/or repairing (describe):------------------ ----------------------------------------------------------------------------------'---'---------------------_------------__- ---------------------------`----------------------------............--------------------------'---------------'-----------------------------_--------'--`------------------------------------------- -----------------------------'9 '-------'-----'------------'--------'-----'------------------------------------------------`---------------------------------------'-'-------`---`----------`---. = I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S�JtaJt,e, laws, -an-d, rules . and regulationsofthe San Joaquin Local Health District. (Signed)_c..!�./.----- .'."'""`��^.'_�[.....-l_. C/�---- - `-. �-G.- "...._.._.._---.--------------------...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----.'_--e ----------------------------------- see REVIEWED BY---------------------------------------------------------------------------------------------------------'-------- DATE._------------------------------------------........ BUILDINGPERMIT ISSUED---------------------------------------------------------------------- ........... .. ..... DATE...---------------_-------------_--------------- - Alterations and/or recommendations---------- ----------- -----------------------------------"-----------------------------------`-----------_-------------- '. ---•-'- --------------------------------------------------------------------------- _ ----------------- - -- ----------------------------- - ---- -------- ------------------------------------ --------------------......- See --------..........................._--___-----_-----_---..........---...._--._-....------------------......_--.._—.-......_..._......-..----------------"'_..-------------'----------------------- -------- ` FINAL INSPECTION BY: ? 7�----- -- ---------- Date---y--Q..-._-rT-------------------------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E. Hacelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISE. 2-5e .. ..t..