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FOR OFFICE USE: G ---------------- ------------ ---------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- -- -----------------------------------t_... (Complete in Duplicate) -------------------------------- ---------------------.-.- This Permit Ex ires 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. ` F r JOB ADDRESS A OCATION ...UE - __---.Gf---------------------------------------------------------------------- -.- - Owner' Name 'f! -1 �_ / --- - ------------------ � ---- ---- -•------- ------------- s --------- Phone:----------------------•------•----- I Address.----'-------- ------ 7 !� ---------------- Contractors Name - !'� T�z.- a ,R ------------------ ------------- Pone. , Installation will serve: Residence partment House ❑ Commercial. ❑ Trailer Court ❑ MMo�ot--��el ❑ Other ❑ Number of living units: __ -- Number of bedrooms __3 Number of baths_-_- Lot size ___ _----'.__1C•/---�>-_� Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to*Water Table -------- ft. ' Character of soil to a depth.3of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Cla rEl Adobe ardpan ❑wl E �� Previous Application Made: (If yes,dpte----------------___) No New Construction: Yes !K ��o Li❑ FHA/VA: Yes No ❑�I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_________________Distance from founidation__,_ -.Mla�te iai_._ eI)) No. of compartments-.--- -------------$ize__ ��`_-- 3�t Ai'ui-d'de th----. 7� y----- Disposal --- :� G i? - -Z�--------Cepacit _ Disposal R d: Distance,from nearest well_________________Distance from foundation____ -----------.Distance to nearest lot lj e_, Number of lines___ Len th of each line___ 1 9 ,•� --.Width of trench --------------------- . Type of filter material-__..�.��_ -Depth of filter material____ /_.___Total length____-- r , ----------------------- Seepage Distance°to nearest well---------------------Distance om oundation__-�-_____.___.Distance to nearest lot line_±------- Number of pits----�-----_--Lining material___ _____�a _.Size: ' f.� Diameter__,3t_.?.,/------ ------ Cesspool: Distance4rom nearest well-_______________Distance from foundation------------.----_Lining mateDrieapl-t-.h_-._..___.._______.'...`._-_-_ ❑ Size: Diameter--------------------------------------Depth- -----------� L•- �- ---------------- Liquid CaPoticY- - - -------- -------------►-_-�_-'g_y. gals-.-. . ,. ' Privy: Distance;from nearest well _..___________---------_`'----------------------Distance from nearest building----- - ''l------------------- ------- ❑ Distance to nearest lot line -------- Remodeling ------Remodeling and/or repairing {describe):-------- - Com'- �� -�- VSTe- . --------------------- ---------------------------------------------------- -------------------- •----------------------------------------------------------------------------------------- ------------------------------------------------ - - j ------------------------------------------ --- ------------------------ .. -+ ---- - ---------------------W------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a , end rule d regulations of the San Joaquin Local Health Disttict: i E {Si ned -----------'----- r'-(,'-- ' {Owner and/ r Contractor) 9 )---------------- --- - ------------------------ ------------------- ----------------- By:. ------- ----- --- Title } (Plot plan, showing size of lock to action of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i . i APPLICATION ACCEPTEDBY ..1✓°� _ .._ J ,------------------------------------------ DATE____ ! REVIEWEDBY ------------------------------------------- ----------------------- --------------------- DATE------------------ i BUILDINGPERMIT ISSUED---------- --------------------------- -------------------------------- ----------------------------- DATE.-------- h Alterations and/or recommendations------ --------------- -------- - ------ ---------------------- I. / ------------ - q I @ ----------�/ a,r ------ --- ---------------------- ----------------- --------------- ------------------- ----------- ----------------------------- ---- ---*/AQUIN --- FINAL INSPECTION BY:-.--.- - ------------- Date-. ----�7- = ; . S LOCAL HEALTH DISTRICT 1601 C Haieltan Ave. "' 300 West Oak Street I F F 124 Sycamore Street c y 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, Corffornia f.RCO. I