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FOR OFFICE USE: I Q00'Z_ '"ree..l'�1 1 ) --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... . _ ...:0 ------------------------------- ------------------------- (Complete in Duplicate) 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.A49. JOB ADDRESS AND LOCATION �� ---------- ' '------L:�?------------------------- .-•--•-- � L ' � ® > Owners Name_....___./ �_,J-e.__.. v __--_- on t r Address' ' 'x'L"V'�r' 11 •------•---- - ------------- ------ Contractor's Name... --------------------------------------------•------------•-------------- Phone..._. .._.... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .... Number of bedrooms -__-VNumber of baths ---I... Lot size ...6.1__-4-j-n...0-------•-----_ ------ Water Supply: Public system ❑ Community system ❑ Private [A Depth to Water Table -I_.5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay, ( Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 1� New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well ro}foundation___.._ -2_.__.Ma e�sl_.... _' _---___-. � �r[y No. of compartments__---_ __! -Size...- Liquid depthCapacity21i)_U__... Dispo al Field: Distance from nearest well- _ ._. .__ Distance from foundation_..k ....Distance to nearest lo,�t line.N✓�.. Number of lines........ ...... ..... .. .Length of each line..!0:n.13_---3DWidth of trench-___- -*_V....._........ Type of filter material..-- -Deth of filter material___/-0./1 Total length..... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest toline._._..._.._...... ❑ 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------------------------------------------ F! __________________--_----- _.-___-_-._.❑ Distance to nearest lot line-------------------_------------------•--•----•-----------------------------•--•--•------------•----•--•------------------------------------ w Remodelingand/or repairing (describe):-------------------------------------------------------.........................................•---..................................................... �0 ---------------•----------------------•-----------------------------------•----------------------------------•-•------------------------------------------------------------------------------------------------------------- ----------------••--•------•----------------------•-•-•-•---------•--•-----•-------•------••------------•---•-•---•-•-•-••------•---------------•-•...------•-----...--------•-•-••-------•-----•------••---•------•-----.... ------------------------------------------------- ------•--••---••----•------------------------------------------------------------------------------------------------------------------------------------------------------ 1 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)•-X--• -----• f"� ---- •. --- ----------------------------------------------------------------------- ------(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 APPLICATIONACCEPTED BY-----...-•-- - --- ------- ----- -- ---............................................... DATE-----------...--•-------• -•---•-- -•---................. REVIEWED BY------------------------------------------------------------------ - .. .. DATE.......-7.r- .�•.-'�Cr--------------------- BUILDINGPERMIT ISSUED................................................ --------------------------- DATE............................................................. Alterationsand/or recommendations----------------------------------------------- ----------•-------------------------------------•-------------•----------------••-------------------------••---- -----------------------------------------------------------------•------...- -------------------------------------------------------------------------••--••-•-•--•--•---•-----•-•-•---------••--•--•--•---•----••-...-----•. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------•-•-•----•----•-•-•-•---------•-•--- -------------------------------------------------------•-------------------------------------------------------------------------•--------------------------------------------............................................... ----------•--------- ------------------------- ------- ------- ---- ------ __--------I----,,-----/-----------------------------------•--------------- ------------------------------------------------------------------ ---- - --------------- Date------------ / `f•' FINAL INSPECTION BY---- ------------------ ---------------- - ----- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E■-9 RMBCD 6.59 I.P.CC.2M 6.60