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• - . _ — _ APPLICATION FOR SANITATION PERMIT Permit No. - ...7. ... (Complete in Duplicate) Y/ - Date Issued Applic:ation 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.s549. JOB ADDRESS D LO ATION---- '-- ---- ---------- - ----_ ------------------------------------------------------------------- Owner's Name --- ---- --- ----- ---- ---v ! ---------------------- Phone------------------------------------ Address---------- r. ----------- ---- - ------------------------------------------------------------•--------------------------------------------------------------- Contractor's Name--- --- -- ----- - ----------------------------------- .-------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Qfhex ❑ Number of living units: A_.__ Number of bedrooms -%3--C -_ Number of baths _Z__ Lot size 1'�_!�___ __ __ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ...-._-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ T` Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or'cesspool permitted if ublic wer is available within 200 feet) aer I _ Septic,,09 Distance from nearest well�"�_�_"�[.e Dista y from jou da fin_/�______.____ . ` _____ ____ ___ _____ ____ [ ' No. of compartments______ __ _________ Size_ _ _� __ Liquid#depth ________ __________Capacity_._ f� -- Dispos Field: Distance from nearest weA_�'2 _Distance from foundationt_ii_ `Distance to nearest lot line__ « [> Number of lines__________ ___.-.-____ Length of each line_________________ Width of trench___.____..,t-dF?"r. ,I -- ,� Type of filter materi ai " epth of filter material____1_ _________Total length_ ----------t _ __ _ _________________ Seepage Pit: Distance to nearest well___-------------------Distance from foundation--------------------Distance to nearest lot line_____._.__.______ ❑ Number of pits----------------------Lining material.-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.---------------.Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. �. 4 . Privy: Distance from nearest well------------ ------—- -------------- ------Distance from nearest building----------------------------------------- [Q� ❑ Distance to nearest lot line .- - ------------------•---------------------- ------------------------------------------------------------------ 'V Remodeling and/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 regulations of the San Joaquin Local Health District. (Signed)---- r=' ==------- "`A ', --------------------------------------- ---------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ---------------------------------------------------------------------------•---------------- DATE3. -----•---------------------------------------------- REVIEWED BY----------------------- --- ---- - ----- DATE__- �.------------------------------•----------------- BUILDING PERMIT ISSUED------------- -----------------------------------------------_------.'------------------------------- DATE-------�---------------------------------------------- Alterations and/or recommendations: -------- -------------- --------------------------------------- A ----------- �" ----------�.��3� �`' ----- _ ,� ? --------Tw------fi [�1 Q G 1�" y�---------11—V---------------------- ------- --------its.� ��-� ?--.-Y.c/? li t� ----- �"7" ------rd,� ' . « ---------------- ------------------ -------------- ----------------- "� "rdt_ +��. `U�.� t _:IU�tT'4r 1 �_r- fel Lc�_'_'_�r=" r2f ------------- -------------------L`' 46�1i`------- -------------•- -------- j?-a8'S __Z_/ GUS 1V rd4) 4-j ej'o'L �5�6 p a.� 'ecrrevor Fa r2 tc;WA. v�C,� f'A ' ,�:e7.'� S"OCVC3avc.e FINAL INSPE6611 BY:------- --------------------------------------------- Dafe--------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1110 South American Straof 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5—'9-2M Revises 1.57 F.P.CO.