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FOR OFFICE USE: 17 L ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . - - - ------------------- ------------------ (Complefe,in Duplicate) This Permit Ex ires 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 described. This a.pplicafion is,made-in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-.1 /4_ ,1 ray Bess--,Xle- _I---�W--- ------------------------ - °��Ow - -/ --------- Address ner's Name-------•1 I_16t�-------!-----6t--As-------------------------------------------------------------------------------------------- Phone.'_Z�"- � Address-------------------Ia -------- ---�-------- ---------------------------------------------------------.---.------------ ----- ---------------- . ........ Contractor's Name----- A_ .s �� '� t�_�Y Ti-----------------------------------------------------------•---- ----------------- Phone__J/b_6_n' 7 ' Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __..____ Number of bedrooms __'Number of baths ----]-- Lot size -___ -___________.__...__._ Water Supply: Public system ❑ Community system ❑ Private 2"Depth to Water Table _1471t. 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 19 New Construction: Yes ❑ No D] FHA/VA: Yes W No 5 TYPE-OF INSTALLATION AND SPECIFICATIONS: V aj a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + . ' Septic Tank: Distance from nearest well---_-.----------Distance from foundation_______________°___'Material`----------_-_-----__._______._____..__._.____.. ❑ No. of compartments Size ----------------------------}Liquid depth--1----------------------.Capacity----------------------- Disposal Field: Distance from nearest weli._1,60__•P_,D+stance from foundation---42.1?_�__._.Distance to nearest lot line w___�_��-_ t ' � xai�• � Number of linesr__________�__________________Length of each line----------y.�____----_.....Width of trench-------o��_ ate= Type of filter material--------?__t;-j{_-Depth of filter material__.___f_ -___......Total length--------------�?d___-_-_________.__- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest :of line__._--_-___._-_._ ❑` Number of pits-I--------------------Lining material-----------------------Size: Diameter----------.------------Depth-----------------_--------------_ Cesspool: Distance from nearest well-----------------Distance from foundation------------ -----_ Lining material______________________________________ ❑ Size: Diameter-- -----------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance fromnearest well---- -------------------------------_-----------Distance from nearest building--_._-_____...______________________..._. ❑ Distance to nearest lot line - --- -------------------------------------------------------------,------------------------------------ -------------------------------------- Remodeling and/or repairing (desc6be):--A.5�_�------�m----I+�.X1:� + J-------�` g•�e''� , k�-I-- / 7 ----------f.UIA------- � --------�- ------ A=A/k-s------------------------------------------------------ ------------------------------------ ---------- -------------------------------------------------------------- --------------- -' ------------- ----------------------------------------------- -- ------------ ---- �erel certif a �I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. (Signed �f_fir Y`__l - - �'��-,:--r- ---------------- -------------------------------------------------------- I (Owner and/or Contractor By:-------- .... -------------------------------------------------------------------------(Title)------- t ---------- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R FOR DEPARTMENT USE ONLY", APPLICATION ACCEPTED BYY - = -- ------------------------------ DATE / /-- REVIEWEDBY------------------------------------------- - ----- -------------------------------------------------------------------------- DATE_------- -------------------------------------------------- BUILDING PERMIT ISSUED-------- ---------- ------ DATE---------------------------------------- -------------------- Alterations and/or recommendations----------------------------- ---------------------------------------------•----------------------------------------------------•------ ------------------------ ----------I--------------------------------------------------'----------------------------------------•----------------------------------------------------------------------------------------------------------------------- I ------------------------------------ -------- ------------ ------- -,-- -------------------------------------- ---------------------------------------------------------------------- ------------------- FINAL INSPECTION BY:..------ _ ` ' - --..._ Date.... . -{ . SA!N OAQUIN LOCAL HEALTH DISTRICT a 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California