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FOR OFFICE USE: --------q__1 ;P1 ------------ -------------- ........... ... tar_.._ APPLICATION FOR SANITATION PERMIT Permit No. __�2✓�__;C_ a -------- „- -- --- ----------------- --------------- (Complete in Duplicate) -------- - ----- This Permit Expires I 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 N . 549. �e ✓ / JOB ADDRESS AND, LOCATI .. _.// / --___ o_�- ---1 Owner's Nam4e � �•------------------ PhaneAddress______ W` � -------- ------------------------- --------- --------------------------------------------•----•------------------------------------ �Ir Contractor's Name_.__. - J ------�---- �� _ ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms --/4/- Number of baths ,�_._ Lot size ./15 __ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 92�544`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Lg- Hardpan ❑ Previous Application Made (If yes,date--------------- -I No � New Construction: Yes ❑ No FHA/VA: Yes ❑ No 1 TYPE OF INSTAttATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) Septic Tank: DistanceJfrom nearest well_________________Distance from foundation_.._ :_-_Ma#erial___-._.______-__-_____.___..________----____._._. P,91 Jfl/P-f No.p compartments------------------ - ----Size--------------------------------Liquid depth------------- ------ ---Capacity------------------•---- Disposal Fiel Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line______.______... ' t Number of dines_---'_t:'------------------------Length of each line-.----------------------------Width of trench.------------- r Type of filter material_________________________Depth of filter materi.al---- --------------.---Total length----------------------------- nearest __._______-___ _________---nearest well-- ----- ______---- --- Distance fr M nda#aon_, - -------Distance to nearest lot line - 0 ©� Number of pits____ ________________Lining material_` _ .__-Size:, Diameter__ Depth_ ,J.-/�9' ` Cesspool: Distance from nearest well _==r_-`bistance from fouhdation__ ---------Liningmaterial-----------------.-----------_------- ❑ Size: Diameter---- --�� ---------------De Depth-------- - m p ----------------------- ---------------Liquid,Capacity---------------------------gals. --- Privy: Distance fromnearest well---------------------------------------------- --Distance from nearest building----------------------------------------- . ❑ ;Distance to nearest lot line _0 -------------------------------------------- ------------ Remodeling and/or (describe}:--------- ---------- 1�'r� -1� L ------------------------------ L------------------------•-----------------------------------------------•-- 1 Y.F - ----------- ------------------------ - ---------------------------- ------•----- 4' I hereby certify thaf-l;have prepared this application and zit'the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulation of the San Joaquin Local Health District. 1 (Signed) ------------ -------------------------(Owner and/or Contractor) ✓ ! BY '`----------------- ----------------- Z- ------------------------------ Title__ 1 .(Piot plan, showing size of lot, location of syste ' relation to wells, buildings, etc., can be placed on reverse side). f f FOR DEPARTMENT USE ONLY ,'7-APPLICATION ACCEPTED BY---------- - - -------------------------------------------------------- ----- DATE--- _/ � --- LREVIEWED BY---------------------------------------------- -------------------------------------------------------------------------------- DATE - ! BUILDING PERMIT ISSUED - ---------------- DATE _...—� - Aiterati s a� or recom endations:__-. _.__._. ,l Vis '` ---0 - ---------------------------- ----------------------------------------••--------------------....-------------........__.... - ------------------------------------------ --------------------- -------------------- ------- ----------------- -- -----------------------I------ - ------------------------- - - ----------.-------------......... ----------------------------------------------------------------------------------- -------------- --------------------------------------- ---------------------- -- ------ - ------------------------------ --------------------------- -_ -------------------------------------- - - ------------ ------- -- ----- FINAL INSPECTION BY:___' ----------------------- Date----- 6 SAN-JOAQUIN�LOCAL HEALTK,DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street V 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 4 F.P.co. 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