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FFICE USE: = & / - ZN -�--- ---- �_ ----------- -------- APPLICATION FOR SANITATION PERMIT _ Permit No. .__..! _ S� ------ -------------------- -- -------------- (Complete in Duplicate)•w_ �r --.--.._. This Permit Expires 1 Year Frorn 'Date Issued3, r date Issued ----- Application is hereby made to the San Joaquin Local Health District fora permit to construct and 4install thefwork herein described. �.. This application.is made in compliance with County Ordinance No. 549.::1 �—.b21J�-� .. , JOB ADDRESS AND LOCAT -. ��a-- ------ �'-- ----'�`°"�--� Owner's Name__-____ "'� � '�'; ` �..-vi i -_ ----- ------•-_---- --------------------------•----------------••--- ------ ----- - ---------- ---------=-- - �----::P one----•-------------------------------- Address, ---------h=-----•-------••--- dress.---- i Ad : ---------------------------------- =--------• -------- --_---------------- Contractor's Name---- - == ..� Phone_ lO�— ,J3/</T� Installation will serve: Residence ❑ SApartment.House ❑ Commer'c'ial ❑ Trailer t �ofel ❑ Other ❑ Number of living units: -- /- Number of bedrooms:____/_ Number�'of baths_�—:`Lot size ---- ________________.____ a_, Water Supply: .Public system ❑ Community system. E1 Private Depth folWater Table q4- ft 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'❑ s Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: {lf yes,date................ ...) No 2---Iqew Gonstruction: Yes Flo ❑ FHA/VA: Yes ❑ No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wet!-S7�r-- Distance from foundation--."V-v _' ..Material.__ - No. of compartments---------�2 --- ---- t Disposal Field: 5ize--- - +1�- --------Liquid depth-----401-------........ Capacity-+ Q- --- - - (� Distance from nearest weli.�Q -_._-._Distance from foundation:J-d___-__.__.Distance to nearest lot line_______.._s I� r Number of lines_-._-_�.-_-.______ _Length of each line-_.--_._�-!>---_.--__.Width of french------� _��__..._- (Type of filter material- _�S_/r_-Depth of filter matenal_.�_-9._- .-----Total length_...----_-_----------- — -----_-_.- (� `Seepageit: Distance to nearest well _1Q4__-_--_-_Distant om foundation__/cd.._._.___Distance to nearest lot line___----__-___ 'Number of pits------r/.-----------Lining material_ 4.c_JV--.Size: Diameter-'_,3_�___-- ---Depth------A. ------------------- Cesspool: Distance❑ from nearest well-----------------Distance from foundation____.--------------Lining materia ........ 1 Size: Diameter----------------------=--- - Depth = i - - ------Liquid Capacity- --------------------------gals. P.rivy:k Distance from nearest well------------------ ------------_---------------Distance from nearest building__---------A__--___-_-_-__------ I ❑ Distance to nearest lot line ------------------------------------------------------ -------------------- ' Remodeling and/or repairing (describe)-----------------------------------------------------------------e------------------------ ------------------•-------------------------- - -------------- ---_--_--__-----__-_-_-___-_.--_--_.--.---_-_.,_.__--_-___ ---_-_----___.._-_.h . --------------------------------------_---------------------------- -------------------------------------------------------------------------------------------------------------------------------------------_---------- ____. I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws and�rule an regulations of A San Joaquin Local Health District, f (Signed) = --- --------- ----- -------- --- ---------------------- -------------------------------- (Owner and/or Contract 1 {O d/o or] 1 By:. �s`-j-----------------------------------------------(Title)_ 4 (Plot plan, `showing size of to+, oca+ion-of system in alafion to wells, buildings, etc., can be placedA' reverse side). 1 FOR DEPARTMENT USE ONLY _ M APPLICATION ACCEPTED BY------------- 4�'.- r-- ----------------:------- ------ --------------------------------- DATE-- - �.�-�, � ,,..,,1 REVIEWED BY------ --------- - DATE --------------------- UILDING PERMIT ISSUED -------------------•--------•------------------------------- DATE - Alterations and/or recommendations---------------- -------- --- -- --- -------------------------------------------------------•- ! -1-6 '- �• ' --------------------------- -- ---------------------- �. . amu - • �- FINAL INSPECTION BY:.....C_-_/�F-------------------------- ---• -- ------------ _.Date------. �f- - S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nozollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street -Stockton,California Lodi,California . { Manteca,California t Tracy,California r.�.cn.