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h/FOR OFFICE USE: ----------------------------- ------------ -------- -APPLICATION FOR SANITATION PERMIT Permit No. ------------- --------41------:----;;------ -------------- (Complete in Duplicate) µ �. ----------- -------------- ----------------------------- This Permit Expires T 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 application_is.made_in_compliance.with County Ordinance No. 549. l g3-25o. 31,. JOB ADDRESS AND LOC - I_� T.C!raGcs! Gt� Wit. , -------------•-- Owner's NameA�a-------- __ ---- ----- --- ---- r -�-------------------------------------------- Pone-------------- ------------------- Address------ �- �- ----------------- --- -------------- --- -- - -----•----- ------------ ------------------------------ ------- -------------------- --- --- Contractor's Name_f ___-__-_ �—S --------------•-------•------ ---------------------I------------- - ----------•------------ Phone----------------------------------- Installation - ---------•---•---------•- -- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ _ , v Number of livingunits: _ `` _____ Number of bedrooms _�_- Number of baths _l__-__ Lot size __��-:xL_7J'4 --------------------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table l_r_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- --------) No 2'�_New Construction: Yes ❑--go—D FHA/VA: Yes ❑ No ❑d a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Talk: Distance from nearest well_La`_D_.�____Distance from foundation__1p__-_______.Material. - ' ------------- -- No. of compartments---- -------------------size___ .3t__ -- -------Liquid depth_-- :-.---------------CapautY-- e'QD Disposal Field: Distance from nearest well.'-0'�_� Distance from foundation%d--F-_______._.Distance to nearest lot line___v__._�.___ ®___ Number of lines------A----------------------------Length of each line-- -a---------------------Width of trench_._._ ___---------- _--- Type of filter maferial`_R k..__..__Depth of filter material--1 _`'.___...._Total length___. --`------------------------ r Seepage Pit: Distance to nearest well.------------ ---------Distance from foundation--------------------Distance to nearest lot line-------_--____.__ ❑ Number ofits________________- nn Lining material---------------------- Diameter___-______._ p g -------- -Depth----------- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------_-------Lining material___..._____-_______._____.___--- _. 'S- ❑ Size: Diameter_. ------------------Depth-------------------------------------- ----------- Liquid Capacity-.--------------------------gals, 9 Privy: Distance from nearest well------------------------------------------------- 7__--_-_-----____Distance from nearest buiidin9_____.__.________-------_--_------_-___-. y ❑ Distance to nearest lot fine---------- ---- Remodeling and/or repairing (describe):________ ________________________ ----------------------------------------- ---- ----------------------------------------------------------------------•-- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I 's, and rule a reg lations of the San Joaquin Local Health District. y, (Signed)-------- - --------- ----- -------------------- --------------- ---------------(Owner and/or Contractor) 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 APPLICATION ACCEPTED REVIEWEDBY - ----------------- ---------- ---------------- --------- ------------------------------------------------ DATEE------- UILDING PERMIT ISSUED------------------ --------------------- - ------------------ --------------------- - --------._ DATE---- Alterationsand/or recommendations----------------- __-------------------- f ----------..--------------------------------------------- --------------- ----------------------- f t FINAL INSPECTION BY:... - -- ------------------------------------r Date------ .1 �' ----------------- ------------------------------- ---------- SAN - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.p.0 O.