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FOR OFFICE USE: ______________________________1J__' --------__----- APPLICATION FOR SANITATION PERMIT Permit No. ___lv-- ........... ; 1-4 ' .. ------- (Complete in Duplicate) ---.--. This Permit Expires 1 Year From Date Issued Date Issued ... r6 � J 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. 5549. JOB ADDRESS AND LOCATI N.-��--"7 ---`'�-,4,1'�"0 ------------------------------------------- --------------- --------------------------------------------- Owner's Name------ =--- - r------------------------------------------------------------------------------------- ------ ------ Phone------------------------------------ Address....... -3._ Contractor's Name._ ------------ -------TA------•-------------------------•----------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __ :!__ Number.of bedrooms .-.2,- Number of baths __ _____ Lot size _.x_-. ' - 4 b------------------------------ Water Supply: Public system ❑ Community system ❑ Private P�'�Depth to Water Table _L__pft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Rardpan ❑ Previous Application Made: [If yes,date---- --------------.) No [2— New Construction: Yes ❑ No Vj' FHA/VA: Yes ❑ No E4— - I 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__Jr_-Q-- -----Distanfrom foundation__l'P_____________Material___ ------------ -----------F_ae_-e No. of compartments-•-- -----------------Size-----T-'----ss-^x--` --_ .Liquid depth-- ---------------------Capacity.. Disposal Field: Distance from nearest well-:47q...(.-Distance from foundation7Q_____________Distance to nearest lot line_,S~_^.._r. I Number of lines----Z-----------•-----------------Length of each line---9o---------------------Width of --.---- Type of filter material-__'l70�-4-..._.__Depth of filter material _--/8-- ----------Total length-----9k_`._c_ -_______________ r - d Seepage Pit: Distance to nearest well/ ------------Distant from foundation---/f---_--------Distance to nearest lot line.---._____ � Number of pits----1---------------Lining mate ria l-4-!----------Size: Diameter----33"--_------Dept h.......ao_'_l.............. .! Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------._______._.____._-_-_____ 111 ❑ Size. Diameter------------------------- ---------Depth---------------------------------------------------Liquid Capacity-------------------------_._gals. N Privy: Distance from nearest well __________--------------------------..---------_Distance from nearest building._-...-_____----------______________-__--- ❑ Distance to nearest lot line------ -------------•-•---------- ----------------------------------•-y-•-------------_------,.--------------------------------------------� Remadeting and/or repairing Idestribe�: < --- ------------------------------� ---- ---------- ----------------------------------------------------- - ------------------------------------------ ---------------------------------------------•-__------------------------------------------------•-•--------------------------------------------------------------------- , 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 regulations of the San Joaquin Local Health District. (Signed) ----------•--------- -- - --------- ---------- --------- --------- ---------------------------------------------------------{Owner and/or Contractor) By=---------------- r ---- ------------------------------------------------------(Tif le)--------------------- (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 �J - f APPLICATION ACCEPTED BY-----`;� ------------------------------ ------------------ DATE------ ----- --------------- ---------------- REVIEWEDBY------------------------------------------------------ ------------------ ---------------------------------------------- DATE-------------------------------------------- •:----- BUILDING PERMIT ISSUED------------------- -------------------------- - ------ --------------------------------------------- DATI=-----------------------------------------------------•------- Alterations and/or recommendations:__.-_-`— `-I-.- �" f >_- _-�____ to -`. 32 ti L ---------------------------------- ` �2--. -yam �-. -if-:�w�-cz --�---c.F __________________________________________________�tr 0 7 ____�_____________..__. _t "'/// f- - --- -------1`t'T-'-------• ----•---------------------------------•-------------------------------- ---------------------- --------------------------------•------- --------------------•--------------------------------------------------------------------`------------------------------------------------------------------ ----------------------------- -------- --------------I-------- ... ---------------- ---------------------------------------------------------------------------------------- FINAL INSPECTION BYDate ` - --------------------------------------------- SAN o -- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r_q.