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f 4 OR OFFICE USE. --- -----� -- ---------------- 'l APPLICATION FOR SANITATION PERMIT Permit No.�I_�.xl ---------- -------------------------------��.--- (Complete in Duplicate) Date Issued _`_ __ ----------------- -------------------------------- Date Issued - This Permit Expires 1 Year From fApplication is hereby mi 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 Ordin nce No. 5 JOB ADDRESS AND LOCATIO 1 �MOwner's Name - ----------- p - ----- Phone Address - - - ` Ap _;---- - --------------------------------------------- � ----------------- M-------------------------------------- ]\lame--- k Phone Contractor's Installation will serve: Residence W-'OAf partment House ❑ Commerli cial ial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms __/-__- Number of baths __/___ Lot size�® ,`. a � !1: I. s , Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to is depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er"'Hardpan ❑ f Previous Application Made: (If yes,date------- - '".-','.] No New -Construction: Yes ❑ No 'FHA/VA: Yes ❑ No g— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is 11 available within 200 feet.) �j Septic Tank: Distances from nearest well __Dis#ante fir m; foundation___ ______Mate lP�4�,f _.._ _______. No, of compartment _. - --__.___`ize9 __ ( Liquid dep`h__. & Capacity__fflA�_ ��-- ' Disposal. Field: Distance from nearest well_o�I_F ._Distance from foundation__Vf/_00........Distance to nearest lot lines ____ Number',of lines---------l__ Length of ea ill line___ ____ _._.Width of french--.2-- - rench__r __ ----------- ---------- i l Type ofl�filter material-/tepth of filter material_.f ____�_._Total length_.__ Q______________ ----------- Seepage Pit: Distance to nearest well ��_____Distance f omlfoundation___ Distance to nearest lot --Linin material____ Size: Diameter_,.-_._.___.._._.Depth_ Number�iof pits.-- � 9 - -� -------- P Cesspool: Distance from nearest well_________________Distance from foundation_____,_____________ Lining material----------------------------------- Size: Diameter--------------------------------------De th------------ �--------- ---------------------------Liquid Capacify ------ als. Priv Distance from nearest well__.___._'___________________-------------!----.__Distance from nearest building--------------------------------------- Distance� to nearest;;lot.Line== ------------------------------- 1p------ ----------------------------------------------------------------- ------------ --------- Remodeling and/or re airiri -------------------------------------------------------------- =,� , ----- --- ------------------------------------ f -------------------------------------------------------------------------------------------- 1 hereby certify that I Lve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and i'rules,and regulations of the San Joaquin Local Health District. = � - - ------------------- ----------- -----� Contractor} (Signed)----------------------- : I" - -- - Title (Plot plan, showing size of lot, location of system in ation to wells, b hildings, etc:, can be placed on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED��$Y---- - �--- �.. - --- ------------------�N------------------------------ DATE--- --- ----- ----- --------- REVIEWEDBY--------------------- ------------------------ --------------------------------- --------------------------------------------- DATE-------- ------------------•-------------------------------- BUILDING PERMIT ISSUED: _. �----------------- --�-------- --:----- ----------------------•�,-------------- - --, ------ DATE.--- --- -- Alterations and/or recomm ndations:-- ____ .` ,i E I =� _ - = ��" ------------------------------------------ --- -------- -------- -----------------------------------------------•----- ----------------------------------------- --------- --------------------------------------- I� ll --------------------------- ----- ------ -----•---- -------------- ---- --- --------------------- FINAL INSPECTION BY:'---.:. -- .. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California