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FOR OFFICE USE: t, f ` APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ------------------------- --- --- - (Complete in Duplicate) 's 7 Date Issued --------- This Permit Expires 1 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. V?'V—0,.S !� c t� ,�, ,,.s� JO ADDRESS AND,�,LOCATION �''' --+-------�- I----------------- { --------------.... f"h Owner's Name 4" -- -- -- - ------.--- Phone-_-------------------------------- ' •---------------------- --• - -•------- Address---------�°`'�'!�-----------------------••--------------------------------------•- --------------------------------------------------------------------'------------- =-----------•-------- e s __ Contractor's Idame'�"-`.--� •----------- �-----••------•-----•------------------------------------------ -----------------------•-------------------- Phone.._-----•----...---------•---- IF r Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2P___ Number of living units: -------- Number of bedrooms -------- Number of baths ------ Lot size _______________ _________________________________._-._._ Water Supply: Public system ❑ Community system ❑ Private ff-_`6`epth to�Water Table J4�ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No UR--New Construction:- Yes ❑.,Nb [5'1FHA/VA: Yes ❑ No TQ- T_Y.P_EzO.F:INST.ALLAT.ION_AND.fSP.ECIFICATIONS:��,,,� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septica Distance from:,nearest well------------- Distance from foundation------------------- Material-______.___.______.______..____._ � - ❑� No. of compartments----- -------------------Size-------------------------------Liquid depth---- ---- Capacity--------------�----�' I Disposal Fiel Distance from nearest well---45"A' _...._.Distance from foundation_Z4.A----------Distance to nearest lot line--.5--- Number ine__ --_Number of lines____ _ Length of each line__.__�l�'__�_____________Width of trench._._2_`tw ._._________ '� DO ' Type of filter material--------a0/k-._._Depth of filter matenal___ _g - dotal length___.__�_____________________________ Seepage Pit: Distance to nearest well-----------____-------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ v. Number of pits--------------_-..----Lining material__-___ ----------------Size: Diameter_____________ Depth----- ------___---------_---- El Size: Diameter---- -- ---- --- De th-- ----- f - p _ ----Lining material---....---------------------.--------. Cesspool: Distance from nearer+ well_______________Distance from fournda+ion---------------- p tq"---------t,.•A------------------------Liquid Capacity-----------........-''-------gals. - . Privy- Distance from nearest well------------------------------------ t .-Distance from nearest building----------------------------- ---- Distance,to nearest lot.l ne....._-_____._.___ _ ` i I] 3 -��. -y----------- �------ Remode ing and/or repairing (describe):. ........... Y � --------------- ------------------ ---------------------------- ------ I _ _ . ------------------------------------=y---- I h6 certify that 1 have prepared this application and that the-work will be done in accordance with San Joaquin County ere ordinances, State''laws,`,and-rules;' d regal tions of the San-Jcaquin Local Health District., (Signed) - -=---- --- ((3s�aMerrand/or Contractor) - _ BY:------------------------------ -------------------- --------------------------------------Title - -- - -- (Plot plan, showing size of lot, location of system in relation 40:wells, buildings, etas., can be placed on reverse side). .. FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY- QAC , -0�1Q :f- ------------------------- DATE------f ------------------------------ REVIEW.'ED BY----------------------- - -------- --------------- ----------------- ------If-------------------------------- DATE----------------------------------------------•------- BUILDING PERMIT ISSUED.>--------`- ------ DATE Alterations and/or recommendations:--------------_____------------- -------------------- r J • ___------------------------_---------------________________________________ F -«___________________ ___________ 1 ' 1 ,_.___.._____}_.¢_____________________________ ----------- -- ----- ---__. __. _._ --------- _. -------__..---_--------_------_-------.-----------_----_------_ .___._____._._-__ -- --- _ _._. _ - _ _._.__ ___.__ _ _.- _ _�_f _ _______________ ______________________________________________________-----_------------------------------------- FINAL INSPE - Date_- SAN JOAQUIN FOCAL HEALTH,DISTRICT 1601 E.Haselton Ave. 1 300 West Oak Street 124 Sycamore'Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co. a