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FOR OFFICE USE: I 0;L v it"Ire 2 n 2 -------------------------------------------------- ------ 1 -_____ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ------------------- (Complete in Duplicate) 7-6 Date Issued -._._________________________-_____--___ ...... This Permit Expires 1 Year From 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 No. 549. JOB ADDRESS AKLOCATION----� J IV �_l_e- f -------- - (-------J--�--.2__!�--------------------------------------------------•-----------+ �,-Owner's Name_/ _ ------------------------------------/ ----------------------------------------- Phone__-__------------------------------- c�J J Address /L= y ----- -��----- .....�--- I/-5-0 < �F 1 ----------------------------- Contractor's Name--4- - - ------- -------•------------------•------------•-------_-_----------------------------------.- _..-------------•-------- Phone................................... Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms ____l__ Number of baths -1.... Lot size _—S _T', .__.1L.� _r-______-__________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table �r-f_2_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E]Sandy Loam Clay Loa Clay �( ❑Adobe Hardpan "y Previous Application Made: (If yes,date--------------------) No New Construction: Yes No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se f Tank: Distance from nearest well o--�_Distan {ro un ion__-__1_�1_____.Materi L, '`L_ -� { -_______. No. of compartments__'7/--------------------S�Size_�___--X_-�____-_-_,-__Liquid depth------------ fir/-.Capacity__/ _'6_.-__. Disposal Field: Distance from nearest well/��0_I_Distance from foundation_.2.0---------Distance to nearest lot ------------- ----- --_.___ Number of lines---' _____- _-_-.-_____ _ Length of each line fl:-a `- ----__.Width of trench__�-1�-______________-.___ Type of filter material�ti_� _1 _ � yp _____Depth of filter material__�`_ S_-__________Total length__-__ '_---------------___________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-------------- F1 Number of pits---.------------------Lining material-----------------------Size: Diameter------.----------------Depth________-_-__-____________-_ Cesspool: Distance from nearest well----------------- from foundation_____--------------Lining material-_______-________________________. ❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_ ----------------------- --------------------.-Distance from nearest building------------------------------------------ F1Distance to nearest lot line---------------------------------- -------------------------------------------------------------------------------------•------------------- Remodeling and/or repairing (describe):----------------- ------------------------•-----__--_----------------------------------------------------------•------ ............................. ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ---------•-----------------------------------------------------------------------------------------------•------------------•-----------------------•------------------------------------------------------------ is is ----------------------- --------------------•-----•----------------------------------------------------------------------------•------------------------------------------------- ----------- -------- ------- I hereby certify that I have prepared thi7ns lication and that the work will be done in accordance with San Joaquin County ordinances, State laws;\and rules and-regulatf the San Joaquin Local Health District. / (Signed)----�-------- ---te--------•,�----'-�----`- _= / ------------------------------------------------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------------- --- (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 APPLICATION ACCEPTED BY------------------------------ ---------------------- -- -- -----------_ DATE ----------------------------------- REVIEWEDBY--------------------------------_----------- -------------------------------------------� _ DATE �r-- � --------- ---------------------- BUILDING PERMIT ISSUED------------------ ---------------------------------- ---------------- ----------- DATE. Alterations and/or recommendations-------------------------------------- -------------------------------------------------------------------------------------- ...... ---------------- ------------------------ ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- ------------_----------- ----------------------------------------------------------------------------------------------------- ---------------------- ----------------------------------------------------------------------------------------------- -------------------------------_------------------------------------ ------------------------ ---------- ------------------------------------------------------------- --------------------------------- ------------- --------------------------------------- ------- -- ----- ---- ------------- --- -- ---- ---._ Date FINAL INSPECTION BY:.- �' A ----- ------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 C.