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FOR OFFICE USE: �� 1'Q �. G�a I ---------------------------- /"3 qe� --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ............... --------------------------------------------------------- (Complete in Duplicate) Date Issued ....__ __._.�_.__�_t --------------------------------------------------------- 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 AND LOCATION----e-A--45-------- c�`�A .. ..............................1=1_ -• -- - - --•--------•-- Owner's Name------------ . ...... ------------------------------------------ ----------------- Phone.................................... ----•-•---------------•-------------•-••----- --------•-•-----...-------•-•-----••-•----•---------•-•----------•---..................... Address Name------------ u---------------------------•-•--. Phone Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1... Number of bedrooms ----I.. Number of baths A..._ Lot size ....5 ';K-.J-4?:0----------------------------- Water Supply: Public system ❑ Community system M Private ❑ Depth to Water Table IT Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClaVJS,, Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date......... ..........) No E"6, New Construction: Yes 177j/ No ❑ 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 well. Ot�___Distanc f o foundoon.._.._410.....Mate ia)t_____________•._........._ ___.___________. No. of compartments...._/ ------------------�jjize._�,��..I�._._Liquid depth......4 04 __Capacity____> ........ "_._ Dis al Field: Distance from neare t well.,494--Distance from foundati,o99----�__o........Distance to nearest lot lily... _. Number of lines-----7_____ _ _______ ____Length of each line_____T40_ it Width of trench-`t" _. Type of filter material, _.Depth of filter material____�_�--_-_______-Total length..... _.Q_________________________ s 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...................................... ❑ Size: Diameter--------------------------------------Depth-----------------•-----------------------•---------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--___----_--•----__---------__-__--_---__. ❑ Distance to nearest lot line------------------- -----------------------•----------------•--------------------------•-•--•-------•-•--•----•--•-----------•---------------- Q Remo eling an8rgpairin (describe) ;S I/ +a----------------------- ---------------•- ---------------------- ------------------------ ---•------------------------------------------------------------------------------------ ---------- 1. .... :......:..::..........................................:.::..................:::.:..........:........:.:..:............:................ I hereby certify t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules' aannd reg ns of the San Joaquin Local Health District. (Signed) ..........-� - _ (Oww Tor ontracfior) 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.................. ------- --- -------------- REVIEWEDBY-------------------------------------------------------------- --- ------ DATE--•--- ----•-!f!.. G� ` BUILDING PERMIT ISSUED DATE---------------------------------------------------- ------ Alterations and/or recommendations:----------•-------- . . . --•--•-•----------•----••------- -------•-----------------------•-------------------------------- -•--------------------------------------------------------------------------••------•------•••-----------------------------•-------------------------•------ ----------------------------------------------------------------------------------------------- -----._...----------------------------------------------------•-------•-----------•------------------•------•--------- ----------------- ----------------------------------------------------------------------------------------------------------------------------------------•---------------------------•------------•-------------- --•----•-- f--------------•-•-- ------ FINAL INSPECTION BY:.---- --- ---------------- Date....... �` 2��`� (............................ 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 ES-9 REVISED EI-59 F.F.CD.2M 6.60 �'�