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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------- ---------------- ------------- - __.... ._ ... ------------------ ------------------------------ ------- (Complete in Duplicate) Date IssuedQ_-1 --------------------------------------------------- ----------------------- 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 instal-ht e work-herein described. This application_is,made.irk compliance with County Ordinance No. 549. Eft_ , s,-_�o c,�ct r ./1 J Z- l JOB ADDRESS AND LOCATION______-_ ' 1�__ ' .__ --------------------------------------------------------�e �4J19��!' 1�' �`�"'�`'� a W - --- - -------- -- Owner's Nam�e �r�-�p�� `/�� LS�_f^_f7�------------ -- ----------------------------- Phone---C��--��c�� Address......_-___/_..1. �� 1 � •� ��'.� -��°..�� /`a�---------------------- � Contractor's Name---------------------=----------•-•-------------------------------------------------- -----. Phone----•---------------------..------- installation will serve: Residence -' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-.___ Number of bedrooms _ .,Y Numb�r of baths ____t__ Lot size __-_____----_a--X---�-�0----_-------------- Water Supply: Public system ❑ Community system ❑ Private X Depth'to Water Table _4_i-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----_--------------) No ❑ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c�17 Septic Tank: Distance from nearest well �,__r--Distance from foundation-- _o_ / Material-----CIDN-cbc' ___________________ No. of compartments------------ _ ------Size__ ` __ Liquid depth__-_-'�----------------Capacity------�G �C-�j Disposal Field: Distance from nearest well-,r.l:�.......Distance from foundation--- o.:_-___-_-Distance to nearest lot line-----j/_____ Number of lines--------------�__.-____.-.---__Length of each line-------Ova---------_-____-.Width of french__------Zk1. !t,c��-- Type of filter materialJ—/,m t'K.A%cb-Depth of filter material------- - °_.Total length_____/�_.io_-_!____________________- t Seepage Pit: Distance to nearest well _/_________________----Distance from foundation------------------- Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material------ ----........----Size: Diameter---------------.-------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance"'from foundation, _______________Lining materia)----.-------_-.____---__--________ ❑ Size: Diameter---- - ------------------------------Depth-------------------------- -- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------- -----------------Distance from nearest building---_------------------------------------. ❑ Distance to nearest lot line--------- ----------------------- - ----------------------------------- ------------------------- -------------------------------------- Remodeling and/or repairing (describe):------- ------------------------- -------------------------------------------------------------- ---------------------•------------------------ ------ ------------------------ ------------------------------------- ------------------------------------------------------------------------------------------------ -------------------------------------------------------------- -------------- ------ ------------------------------------------------------------------------- -------------------------------------------------------------------------t = ----------------------------------- --- ------------------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------•---------------------------------------- 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)-----------•-6�4 - - - - ------� --- --- ---------------------------------------------------------(Owner and/or Contractor) \ By: i --- -------------------- ----------------(Title)-- --- -------------- ------------------ ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_.-._-___ -- - ----------------- - ------- ------------- -- ----------------- DATE---- fG-"'f�``��- --------------------------- REVIEWED BY----------------- -------------------- -- -- ---------- DATE BUILDING PERMIT 155UED -- - ------- --------------------------------------------------- DATE Alterationsand/or recommendations:----------------------------------------- -------•-------------- -----------------------------•-•------------------------------------------------------------- i ---------------------------------------------------•----------------- ------ -------- ---------•------• - --------------------•------ ---------------------•---•---------------------•------------------------------- ----------- I---------- --------------------------------------------------- --- -------- ----------------------- ................ ---------- ----- ------ - ----------------------------- ----------------------- •------------- ------------------------ -- ------------------------------- FINAL INSPECTION BY ------ ---------- Date-_--:3 Zd-1--6-1�------------- - ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i