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Furl%lFFV_L v,au Permi APPLIC. . .JN FOR SANITATION PERMIT t No. . �- --��?r ---------------------------------------------- (Complete in Duplicate) Date Issued 47 ------------------------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for 4 permit to construct and install the work here described. This application is made in compliant with oun Qrdin e N 549. �S �/D JOB ADDRESS AND LOCATION -- ---------- ----- . t.-- �' Owner's Name---------.�-- - — -41%.---- Phone._... Address______ L _.. U� �>l-------------------------------- ------------------------------- Contractor's Name------------------------------------------------------------ - ••-•------------•------- Phone------ ---•--.---------------- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms --- --- Number of baths _ ---- Lot size —__________________---___.._____._ Water Supply: Public system ❑ Community system ❑ PrivateN Depth to Water Table Z"_Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date I No ❑ New Construction: Yes ❑ 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 well___S._C2 _.Distance from foundat'on------I_S_. .__Material....(A-_ _____________________ IK] No. of compartments_._.___------------- _,___Liquid depth_.._.--_--___-__.._Capacity.-I_..t{...-------- Disposal Field: Distance from nearest well.4D........Distance from foundation... -P'_.....Distance to nearest lot line_`>_--_._____--- ® Number of lines-...-.?______________________.-_Length of each line------?o--r__7-a----..Width of trench �$>___- r q_,!--_____-- r Type of filter material_-_...... _.._.._---Depth of filter material__ Q_.!...............Total length_jlb'______________________________ \`N� Seepage Pit: Distance to nearest well- __.---------------_Distance from foundation._____-_-__-..-_--Distance to nearest lot line._-___.-.-_-__ V) ❑ Number of pits-__ ------------------Lining material____ __ ---------- Diameter---------__-__- ___.Depth. ----------------------- ----.__ 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-------------------------------- ---------------------------------------------------------------------------------------------------- Remodelingand/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, and rules and regulations of the San Joaquin Local Health District. (Signed)---- • ------------ I� — -�- ---------------------------- - ------ ----------------- ---- --- - (Owner and/or Contractor) BY lJ,�= 1 `. --- "_----------------------------- Title -- -- (Plot plan, showing size of lot, location of system in relation t'� wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------------------------------- DATE_---- REVIEWEDBY------------------------------------ ----------------------------------------- -----------------•-------------------•------- DATE------------------------------------------ BUILDING PERMIT ISSUED. -------•- =_ - DATE-------- .. - - 4 Alterations and/or recommendations:----__--• -- -- � :.--::-'--s_____-G%,�r�� -•--�,: - -•",-----�----- •-- ---- ---------------------------------. - ---------.. ----�---- --- ----- -- ---- -- r' , cc..- - - ----7t -- =------------------------ -- ------- -- ----- - ------------------ - - ------- ........... ------------------------------------------ -------- -----.._.._ --- --------- ---------------------------- --- ------------------- FINAL --------- - -- -----FINAL INSPECTION BY: _y.- / / 1.� --�� - - � - - _ 4. 6 Date.. .. _ . - -- - - - -- 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.P.CUJ