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FOR OFFICE USE: _ .. ----------------- ----------------- ------------------ ,. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- l ...... (Complefe•in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued do O r Application is hereby made to1he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compli n e with County Ordinance No. 549. ,,,, JOB ADDRESS AND LOCATIO _ ) E_--., neo_14--._____ --V.l(.__0---------S ATL--t_.F f=---••----------G /gLOiV Owner's Name-----------F 13.3 NX_!nJJ'J--------D--- BF—E&� -------------------------------------- = Phone_-,------•----------------------- Address------------------I _: -------- Contractor's Name----FRe-t;k----Ap1B_1,3l..`rlf-5---------------------------------- ------- ---------------------------------- ------ Phone------ •-- -----^----------------- Installation will serve: Residence fT Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: __ ----- Number of bedrooms __ Number of baths_ Lot size __ _ ___ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table3-5- ft p Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamClay ❑ Adobe ❑ Hardpan ( Q Previous Application Made: (If yes,date......_--------- . ] No New Construction.- Yes Z-'-No ❑ FHA/VA: Yes RT`�'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_-_�?�....------Distance from foundation_.. &-9........ Material .WNK-_-gTZE-____________-- No. of compartments----._.____. ---_Size.__ X10x_t-57Liquid depth____V'__Z-____- Capacity__I`L_©_P--__ Disposal Field: Distance from nearest well_-s:7.d......Distance from foundation___l-0_"---...Distance to nearest lot lir e___��._____ Number of lines-----------�-.. .--------Length of each line__ _5—4--5-a....Width of trench___-2.y.________,_________._ Ic Type of filter materia4__ Q_C-X_..__Depth of filter maternal___ ` -_--Total length_._____.__/QQ__________________" Seep Pit: Distance to nearest well....�049--------Distance from foundation-__-.fD------- Distance to nearest lot line__S-__-------- Number of pits._. ____._.__Lining mate ria l__p-0-CAK---- Size: Diameter_.y ..T?_ ___--Depth____..fy___- Cesspool: Distance from nearest well ________________Distance from foundation----------------- . Lining material-------------------------------------1 ❑ Size: Diameter- -- ------------ -Depth-------------- ---------- - - --- ------ - ------Liquid Capacity----------------------------gals. Privy: Distance from nearest welf----_______________________ ----_---------Distance from nearest building_._.__-_____.______._-______..__.------- - ❑ Distance to nearest lot line ------ "--------------- -------------------------------------------------- Remodeling and/or repairing (describe}---------- -----------------•--------------------------------------------- ------------ ------------------------------ -----------•-----•---------------- ----------•-------------------------------------------------------------------------------------------------------------------------------•--------------------------------- -------------------- ---------------------------R ---------------------------------------------------------------------------------•-------------------- --------------------------------------------------------------------------------------------------- --- I hereby certify that I have prepared this application and #hat the work will be done in accordance with San Joaquin Count ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. Si ned ( g ) _ ... ..:. ---- :...... .......:." .�----- ....... _ AOwner and/or Contrac#or�_ .. By--------------------------------- ---------------------------------- ------------------ ------------•------------- --------------(Ti#le) ---------- --------- - - { (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-- ------------------"----- BUILDINGPERMIT ISSUED.--------- --------- --------- ---------------- ------------------------------------ ------------- DATE----------------------------------- Alterations and/or recommendations:---- . ------ -------. . -------- ----- --- -------------------------------------------- ------------------- -------- --------------------------------------------- ----------------------------------- ------------- -------------------- - - --------------------- ------------------------------ -------- --------------------•-"----------------------------- ------------- ------------- -------------------- ------------------------------• -----------------•------------------------- ---------------------------------------------------------- -----------------------.------------------------------------------------------------------------- ------------------------- --"- - --------- ------ . --------------------- -------- --------------------•-•---------------------- ---- - ......... .... ............................ ------------------ --- - --------- - ----- ----- FINAL INSPECT ---- --- ---- Date ------� � - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.lfoielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.N.9 2M 1.67 Vanguard Press ysa .±-