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FOR OFFICE USE: //,'g a ;APPLICATION FOR SANITATION PERMIT Permit No. .p- -------------------------------- --- ---- - ------------- (Complete in Duplicate) � Date Issued -------- --- ...............___.__________ This Permit Expires I Year From 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.._ /,_i6b_a ---f.3_7r_, � ___ Owner's Name----- =r`---------- ------- ------------------------- --- ------------ ------------- - -------- Phone- - ---_47( 3. Address---- l._ / -'7Sr � Q --------------------------------- ----------------------•----------------•-----•- Contractor's Name-------- ---•- ---- _._ =--------------------------- --------------_=-------=_:.- .._: Phone__1-fA__Y',4_.Z C Installation will serve: Residence ❑ 'Apartmenf House-E]—commercial ❑ Trailer-G-eert Motel ❑ Other ❑ Number of living units: -1----- Number of bed, rooms _/ .. Number of baths _f.`_ tot size ------------L _-0-___. __3—a_ ------------ Water Supply: Public system ❑: -Community system ❑ Private `Depth to Water Table _2.p_ ft. Character of soil to a depth of.3 feet: Sand Za" Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (Ifryes,date-_..__..._!;--------) No 0" New Construction: Yes ❑ No [� FHA/VA: Yes ❑ No 25--" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from found rion_J0__F._____.Material______ _______________ __________________ ®/ No. of compartments--_-__�___________ __5ize____.3_�xS_ _!�:__Liquid depth____._4r*0..._.____.____ ------ e e, Disposal Field: Distance from nearest well___3^ ____Distance from foundation___f a___._..Distance to nearest lot line____..____. Number of lines__:_____.2----___..._. Length of each line_______AQ'_--_-.___---..Width offrench-----2_--________________________ Type of fiiter.materia!__ -_---Depth of filter material-----/_ _��._.._Total length------- Seepage Pit: Distance topeares# well________________g Distance from foundation--------------------Distance to nearest lot line_______________._ --- ber of its----------------------Linin material---------------_-_ ---.size: Diameter----•------------------Depth-----.--------------------------- Cesspool: Distance ro best well-----------------Distance from foundation--------------------Lining material-------------------------------.------ 7 ❑ Size: Diameter_____'-------------- -------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________________ --------------------Distance from nearest building------------------------------.______..._.El y' Distanceto nearest lot line------- ------------------ ---------- -- ---------------------------------------------------------------------- --------- --------------- Remodeling and/or repairing (describe)___________________________ _ -- t _-------.-•----------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------- -------------------- I { 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 andiregulations , of the San Joaquin Local Health District J (Signed) �+� ✓fir ------------------------------- --------------- - --------------- --------(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_ -=-- -- "_1----------------------------------------------------------------- DATE-----.0--J-97-6'.6------------------------ -- REVIEWEDBY------------------------- --------------------------------------------Z------------------------------------------------------- DATE---•---- ---•----------------------------------------------- BUILDING PERMIT ISSUED---•--•---•---------------------------- y - - ------------------------------------- DATE--------------'---------- Alterations and/or recommendations-----------=------- -----------------------------------"n_----------------------=--------------------------------------------•----•-------------------------- -------------------------------------- --- ---- ---------- - -------------------------------------------- -------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•------------------------------------------------------------ - -•--------------------- -------- --------- ------- ------------------------- � G- FINAL INSPECTION BY:............ ...1. ;.l r-----.� ------------ Date-___-------- � �� - E SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton, California Lodi,California Manteca,California Tracy,Califarnia F.F.CO.