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FOR,OFFIICE�USE: - -------- ----------------------------------------------- F APPLICATION FOR SANITATION PERMIT Permit No. -- -------- --------------- ----------...-------. (Compleie•in Duplicate) ---------------------------- This Permit Expires 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-�---r---�J.Q_f�-- �=------Lo-i�-- 5 ---- ------M TS --------------------------- , Owner's'Name------------------ - 1 - I _�l _.---- ----- ------ ------------- Address-/r - - Phone -- 11,5 1 _pl_ �? - - )_ -1 !_1` Ll_ �........ Contractor's Name ------------• -------- ---------------•---------- ------- -------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __i-.--- Number of bedrooms-5-_ Number of baths/----- Lot size _,120___x__.� d_________________________ Water Supply: Public system El Community syste Private E] Depth to Water Table --;�/ft Character of soil to a depth of 3 feet- Sand Gravel ❑ San Loam ElClay Loam E] Clay E] Adobe [-] Hardpan E]Previous Application Made: (If yes,dote_- .------- l No New Construction: Yes ❑ Nci t FHA/VA: Yes ❑ No [f--t-1 TYPE OF INSTALLATION AND SPECIFICATIONS: r (No_septicjank or cesspool.p r.mittedYifrpublic_sewer�is available witbin 200.feet.] Septic Tank: Distance from nearest well----------------_-Distance from foundation--------------------Material ___._._.____..___._._ T) NC7 No. of compartments--------------------jize-------------_------ -----------Li uid de th--------- ----- ,----- -Capacity Disposal Field: Distance from nearest ,1,,. ,- istance from foundation___._f .._ Qistance to nearest lot line___.r_t_____._... -- 1~05-TI NG Number of lines; - _ Length of each line------ .Width of trench. _-- — __ !.._ `--elf ID ' Type of filter mater1ai_..t�t_CK _Depth of filter material____.1_ -----------Total length---___23-------------------------- ---------- Seepage ______ ___. S1 Seepage Ps Distance to nearest-well..._Cr.__.________Distance from foundation____.1 -------Distance to nearest lot line___�- ._____..__ Number of its._ ............:_ _Linin material--/ OC . Size: Diameter___ ______._ __. P j 9 7 X Depth-----.-- Cesspool; Distance from nearest well ________________Distance from foundation------------.---- -lining material------------------__------- ---,- ❑ Size: Diameter- - -------------- ----------- ----Depth------------- -- ------------------------------Liquid Capacity----------------------- ----gals. Privy: Distance from nearest well............................_.._..__.-.._.._...Distance from nearest building------------------ --------------------- ... ❑ Distance to nearest lot line_---- --------- ---------------------------------------------------.---------------------------------- ------ Remodeling and/or repairing (descr,ihe) ------=-- - ----------------------------------------------------------------------- ------------------------------•---------•---------'----- I i - - ------•------------------------------------------_.---'-----••--------.---------•-•------------------------------------_ ----------------------------------- • *I -� ----------------------- -------------------------------- --------- - ------------------- ------ --------------- I hereby certify that I have prelared this application and that the work will be done in accordance with San Joaquin County ordinances, TS4.e, laws nd r s and regulations of the San Joaquin Local Health District• (Signed)-- - -------------------------------------------------------- ----- [Owner and/or Contractor) __:� - '---`-�`�'-�--- � _ _ - _ (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 f APPLICATION ACCEPTED BY. =-/ 'a=Ta O ------ ------ ---------- ---------------------------------------- DATE.--------- --------------- ! REVIEWED BY--------------------------------------=f ------ DATE----------------------------- ------=---- ----------------- BUILDING PERMIT ISSUED--------------I---------- ----- ------------- DATE------ -------------------- ------ ------------------------- Alterations and/or recommendations ------------ - ------ -------- -- -------- ----------------- ------------------- -•-------•----------- ----------------- i -- ------------------ -----------•--------------------- ----; 1 r --------- ------- - - - ------------------ -- ---------- ---- - --- l FINAL- --- --------- -- Date �'y.l�... ? � '°iNSPE -,.SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellan Ave 300 s Oak Street 124 Sycamore Street 20.5 West 9th Street 4 Stockton,California f Lodi, California Manteca,California Tracy, California • ,, �. .�R g,. E,H.9 2M.1.67 Vanguard•Press t,,