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FOR OFFICE USE: w: -._.-_. ......... APPLICATION FOR SANITATION PERMIT Permit No,o2s_ ------------------------------- -------- (Compleife•in Duplicate) > This 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. 55449.. ,,j JOB ADDRESS AND LOCATION....41�------So.--.��t'/1'�-4--------------------------------------------------------------------------------- Owner's Name-------/_ .---��Z7.X------------------------------------------------------ -- - --------------------------- - -.__._ Phone---r/l� Address �1.. _ v '�f y� --------------------------- ------------------------------------- ----- ------ --------•-•------------------------- Contractor's Name ,�Js [�-'� � - ------ ------- --------------•------ ------ ------------•--- Phone----------------------------------- Installation will serve: Residence [��-<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s � Number of living units: __/_ Number of bedrooms _..___-- Number of baths /___ Lot size -_ .l�Q______________________.____ Water Supply: Public system U?_**�Communit system y stem ❑ Private ❑ Depth to Water Table , Oft , Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe 0---Mardpan ❑ Previous Application Made: (If yes,date------------- ..... ) No ®/'New Construction: Yes ❑ No R3w—FHA/VA: Yes ❑ No Q-- 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-----------------Distance from foundation------------------ Material --------.--------_-__-_.._____._.____._.___.. f.. E& No. of compartments--------------- ----------Size------ ------ -----------Liquid depth--------- - ----- ------- Capacity------ ---------------- Disposal Field;. Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-_-------_-___--- A+KI/$'t!Ny Number of lines----------------------------------Length of each line-- -------------------- ----Width of trench_---------------------------------- Type of filter material-------------------------Depth of filter material-___-------------------Total length-------. -------------.._----_-_---__-_--- f Seepage Pit: Distance to nearest well____- �-____._Distance fr m fo�uindation--f�_._.___.Di;tance�o nearest lot line_s��._�-__.__ Number of its-__ .�_____.__._.-.Linin material.. _ -_Q�/C Size: Diameter__ __ _ .. .0 p 9 '�*--%! _?..... Depth--�-f----------------- 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 -------------- - -------- - - Remodelin and/or repairing (describe)_______________��_- f--.-.---- - _� Z�KeSl _ r-------- -- -------•------------------------------------------------------ ---------------------------- -------------- ----- I h eby 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) 0 � r Ad.t�-------f- ---- --- - - ----•----------------------------- - ----(O�or Contractor) By:-------------------------------- -------------------- ---------.-._ . {Title � elf -- .._...... ----- - ---- (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------------------------------------------------L-------------- DATE-- --- ------------------ REVIEWED BY------------------------- ------------------- --------- ------------------------------ - ----------------------- ------------- DATE------- ------------- U! DIN PERMIT ISSUED-------- ---------------------------------------------------------------------------- -------------- DATE ------------------------------------------- Alterations an or recom ndati s:.--------- ----------------------- ------------ ------------------ - --------------------- ---- ---------------------------------- -- -c _./��- -s-L --------- ----•---- •----------. - - FINAL INSPECTION BY:... 'r ---------------------------- - --------- Date------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press