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VUK UF-HU USE; ---- -- ------------- - -------- APPLICATION FOR SANITATION PERMIT Permit No. .. _1t ------------- ---- --------------- ---------------- [Complete in Duplicate] ----- � ------------ ---- This Permit Expires 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 describe . This application is made in compliance with County Ordinance No. 549. ]�] �© � ' [ 1 JOB ADDRESS A D LOCATE N_ /- - -----------j �_.__ _____ .---fit --- �`- 1 C (�Z1_ Owner's Name - --• -------- --- - ---------------`- --------------------------- - Phone-----------••--------------•---•---- ' Address �' < f - - -------------------------- :57 -- -- -- ------------------- Contractor's Name--_ 4)6 _.___ --------- ------ ---- ----------------------------------- ------------------------------------ Phone.- G ----S Installation ..._. will serve: Residence ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _Number of baths -1------ Lot size ___4 R_P�e if Water Supply: Public system ❑ Community system ❑ Private ]W Depth to Water Table /2�-ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ..Previous Application.Made:. (If yes,dote-__.--- —......) No P'ew Construction: Yes ❑ -No A/VX Yes 0 .—No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well-.._ _�� Distance from foundation--/ ----------Material------. -----------__________ .._-_...______. p -- 3 j x_:;�--•---Liquid depth-----� ---------.Capacity-J-ap No. of compartments _.. _ _____.__Size: _______ n Disposal F• Id: Distance from nearest well.-� ----- Distance from foundation---/ ___.__....Distance to nearest lot line---`6_._---____. rNumber of lines-----69 __--------Length of each line__.- _.� -.Width of trench 24�. _ _______ Type of filter material,� tl µ'� `( ______Depth of filter material�_�_ _____________Total lengtft------l_0�............................. - -- ------- Seepage Pit: Distance to nearest wef)----- ----------------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_----___---_---_.._._-.-._ ❑ Size: Diameter_- ------------------- -----------Depth----------------------------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------- _--Distance from nearest building------------------------------------------- uilding _----_-_-__---_--.- - ---------- Distance to nearest lot line______ ----- Remodeling ___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, St t-o laws, and rules regulations of the San Joaquin Local Health District. + (Signed) --- --- ------------- -----------------:-• ------------------------------------------------------[Owner and/or Contractor] � r By:-- -------- - -- ------- ----------- -------------- ---------------------------- (Title) [Plot plan, showin Ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------F_(._ a.......-------------- ------ - — q --------------------------------------- DATE------ f { = ............ --- REVIE WED BY-------------------------------- --------------------------------------------- - ----------------------------------------- DATE-------------- ----------------------------------------------- -------------------------- BUILDING PERMIT ISSUED-------- ------------------------------------------------------------- ------------------------------- DATE Alterations and/or recommendations--------------------------- ------------------------------ - ------------------------------------- ----------------- -- ----- 1 ----------------- -- -------------------- - --- ----- } , - --------------------- - ----------------------------- FINAL iNSPECTi©N-8'I'; �_ Date f1" ' moi SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P,C O.