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FOR OFFICE USE: gr ; -- ------------//-; � � "� �________________...____�.�_. _ APPLICATION ' Fo'r SANITATION PERMIT Permit No. + _ ' '"` (Complete in Duplicate) - Q ------------------------------------------------------------- This Permit Expires i Year From Date Issued Date Issued7- r77-- Y' o_a'7 Application is hereby made to the San Joaquin Local Health District fora er it to con ruct and i sta he wdrk�eyeinkescribed` This application is made incompliance with County Ordinance No. 549.' per ��✓✓,,�� - - JOB ADDRESS AN LOCATION---_----- --t. - -- -�a---.�llc -- ---------- Owner'sName-- * ' one Address -•---•--- -------- --------------------- Contractor's Name � --4D --- -------`�-- Phone..__'�ic6 _-_ _ � �` I Installation will serve: Residence ,Apartment House.-E] Commercial ❑� Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___f___ Number of bedrooms -3_._ Number of baths _/___ Lot size ___ -L� --- _---___--------- ---- Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depthl�.of 14eet Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made. (If yes,date__.-----------------) No ❑ New.Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se c Tan ce from nearest well-----------------Distance from foundation_._) ___._____.Material______..____...__ _-_._____________..._____--_. No. of compartments-.---- ------------Size--•------------ = - Liquid depth-------------------------.Capacity----�®- f � qq ( osal Imo' Distance from nealrest well.1_�----Distance from foundation... ._______.Distance to nearest lot line_____A-_______. Number of lines___f-_____ .___ ____ _ _ .--Length of each line__g.Q__�_ Width of trench _Z ------------------------ Type C�r.-__________ o T e of filter materia r � yp - 1.1t:_Depth of filter materiaL______;{__ --------.Tata# length___ ------------._ , n Seepage Pit: Distance to nearest well ___...___.----------Distance from-' foundation--------------------Distance to nearest lot line______.___=_ _:- ❑ Number of pits-----:--------- 9 --` .'S - =-"--- --Size: Diameter ------- -----------Depth-------- -------------- p r 1 foundation--------------------Lining material---------------------------------�-�� Cess ool: Distance from nearest well____-'nl�__..�D stance from, n �0 Size: Diameter Depth ',-------------------------------------Liquid Capacity--------------------------9�5 Privy: -�Distanee,�from-nearest well__ - _- .: _, r.,4...Distance,from,nearest.bui in g ❑ Distance to nearest lot line-------------- -- ---------------------- ` Remodeling and/or repairing (descte14-:7 : ---------- -- -- _i_ - .. r r+ - - I _____._____,____________________________________________�___--_w__r------------------------__ ------------------------------------- _ ______ _ __.____ ._______._- __________________.__ __________________________________ _ _ _ _ y S I hereby certify that I have pr�epared'this applicaTior and that+hety arkwill be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of�the aIJ aquin Local Health District. i (Signed)- -' --------------------------- - ------- --- --------------------- ------ �A�®rract r �EPT1C TANK 51=F2V1CLQ- � ' nt o - --------=s�.�`-------------------- - - • -- ----- -- -----------(Title)------------ ---- _ ..... .......... ---z (Plot plan, showing size of lot, location of system in refatio o wefts, buildin ; etc., can be placed on reverse sidl). .i: FOR DEPARTMENT USE ON�LL(.,�..,. (; APPLICATION ACCEPTED BY_ = - lI` ---------- DATE------ � --•---------------- REVIEWED BY-------------------------------------- i ------ DATE - BUILDINGPERMIT ISSUED------------- -•-- -------------------•---------------------- z = -------- ATE----------------------------------,- ----------------------- Alterations and/or recommendations:__.__ ' _ -- -----•- ----- ------------------------------------------------------------------ 11. k _______________---------___ ----------------------- AI.y:.T- ..ry, y .._vim. •. ..._ .. _. 1 _ ---------------------------- --------------------------_____-----------------------------_----------------------------------------.---------------____-------------------__..-----------------------------------------------------_-------------------- ------------------___________________________________________________________ -------------------------------_--------___________-------------__--------------------_________________________________________________________ FINAL INSPECTION BY: - --- ---- ------------------------ a Date......... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' Stockton,California i Lodi,California Manteca,California Tracy,California 1 F.P.CO. 49