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FOR OPFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- -- --- -------------------- (Complete 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. 549. _0-7 — 2�OB ADDRESS AND LOTION-___-:- _1 -- ---- 1 ( i :Owner's Name _.. ----- -------------------- ------------------------------------------ ----------- Phone------------------------------------ 4 Address------------ r :` 1 X----y - ! = ' _ ------------------- ------...----- C p Contractor's Name1�11d1 _..__Sl 1 ]- �� L �(I_Cl ---------------- --------------- Phone----------------------------------- Installation ---••---- •------- -Installation will serve: Residence Ell-lApartment House ❑ Commercial ❑ Trailer Court E] Motel L] Other E]! Number of living units: ----- Number of bedrooms �-a�_. Number of baths !=_._ Lot size --------;� ------�_ ) - L...... Water Supply: Public system ❑ Community system ❑ Private ij"Depth to Water Table3:� ft- Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ©Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date------------------- ) No New Construction: Yes,2-'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�_----Distance from foundation__./C?__-_.-__ Material.. '� _ "F�— --- -----t`'------- - -------Liquid depth-- P y-- -• No. of compartments..._._�________.._Size_ ` .-....Ca acifi �` Disposal Field: Distance from nearest well..,?~.. _._.._Distance from foundation___ --------Distance to nearest lot ______ # 2L ., � ©� Number of lines------------------------------------- Length of each line---------------.- -.-_:__--._.Width of trench-----,----,:-,-------------------- �D � [, of filter material-__ Q. .Y-----Depth of filter material------ _-_--.-.Tota! length_-_________��------------------------- Type Seepage Pit: Distance to nearest well----7 ..........Distance from foundation------/0----.-.Distance to nearest lot line_____ ________ ❑' Number of pits----- Lining material__F?0C K_,_-Size: 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 regulation o the San Joaquin Local Health District. (Signed)----- �= ��` =" - --------------------_- ----------------------------�---------------- --(Owner and/or Contractor) B.y=------------_-- ----------- ----------------------------------------------------------------------------------(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 i APPLICATION ACCEPTED BY---------=1---t R-:0- ------- ---- ----- ------ ---------------------------------------- DATE---------- 1.--"`j._ 6 REVIEWEDBY----=----------------------------------- -- ---------------- --------------- - ------------- ---------------------------- DATE------------------------------------------ ---------------- BUILDINGPERMIT ISSUED-------------------------------- -------------------------------------------------------------------- DATE------------------------------------------- ----------------- Alterations and/or recommendations: ------------ ------------------------------------------------------ =----- ---------------------------- -------•------------------------------------------------------ /- .-.... Q UC D CO U(x`'91 JW N_�-s ---------- -- --- --- ----------- --------- ------------ -------------- - - Q. --------------------------------------------------------- ------------ -------- ------------------------------------------------------------------------------------------ ------------- -- - -- - -- -- -------------------------------------- .1� -- ---- ------ - ---------------- ---------------__-- --.- --------------------- FINAL INSPECTIO f -'` .= Date - /. C - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,kaselton.Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California r.P.0 0.