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.01 -------------------------------------------.------------ APPLICATION FOR SANITATION PERMIT Permit No. . - _ �`� ------ ---------- ----------------------- --------------- (Complete in Duplicate) --------------------------- --------- -------- --- This Permit Expires 1 Year From Date Issued Date Issued Z-2_-62.74 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_.. ^_' ------e012 0 �-- , KT RA----e9Alcl 00thVe l ' Owner's Name-- p_r -------------- Phone------- ----------------------- , Address------='--6_; 'fa�4-1A ------��--��--------••---- �-��'_��sem' --------•----••---------•----•----------------------------------------------------------- Contractor's Name------ r Phone.-.-•-_ c. - � or Installation will serve: Residence (g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ - Other ❑ Number of living units: --___'Number of bedrooms _ Number of baths -------- Lot size _ ' :_- jlff -- ----- Water Supply: Public system ❑ Community system ❑ Private 10 Depth to Water Tableft, Character of soil to a depth of 3 feet: Sand `[q Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe E] Hardpan ❑ -Previous Application Made: LIf yes,date--------------- J No NewJConstruction: Yes ❑ No ❑FHA/VA: Yes No ❑ �. . - - _ . �... Y_ �.. Y 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_._�7 ---_Distance from zfoundation_ 1 � Material----------- _ i ____________________No. of compartments---------9---------------Sie-_t & f quid depth---- Capacity _-_-_-_-_-_- Disposal _ Field: Distance from nearest well--- a' -.___Distance from foundation___.______--.Distance to nearest lot line___________._ ') ® Number of lines------_--------�'---- -_-----Length of each line_._____`�._�`�___�-�.�----.Width of trench._____r_�_____-. Type of filter maferial--------__-- .--_-Depth of filter material_______ -_ ----Total length------------------------------------------ Seepage ------------ - --------------Seepage Pit: Distance to nearest well----------------------Distance from foundation_______ _____________Distance to nearest lot line..____________.._ �I ❑ Number of pits----------------------Lining material-----------------------Size: Diameters...------------------Depth-------------------------- -.- Cesspool: Distance from nearest wefi________________ Distance from foundation._____.-------------Lining material__.---._.__.___.___.__--___.____;____- k ❑ Size: Diameter-- ---------------- -------------- Depth--------------------------------------- ---------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _______ ------------------------Distance from nearest building--------------------------------- 171 Distance to nearest lot line---.__--------------- -------------------------- Remodeling and/or repairing (describe):_____.__ftl)l_ _ �JM� ----- �: sr , -- ---------------I---------------- J' -- I --------------------------- ------------------------------------------------------•---------------------- - - ----- -- -- - -- ---------------------------------------- --------- 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)------- t----------- -'` "''�' -- - --------- ---I-------------- - - ___,__Owner and_or_Contracfar By:--------------------------------------------•------------------ - - -- ----- t - - - - - -- ------------------ --------------- -------{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---TRIO------------- -------------- ---------- DATE------I�_-_�` REVIEWED BY------------ -- ----------- DATE----- -----•-----------------------•---------------------- BUILDING PERMIT ISSUED - = --------------------------------------- DATE Alterations and/or recommendations:----------.--- --------- ----------- ----------------------------------------------------------- ---- ------1� __w ----------- ------------------ •-------------------------------------------- ------ p'P ` FINAL INSPEC �� W -- --- --- -- Date.------- - -- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California j r