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FOR OFFICE USE: - -- - APPLICATION FOR SANITATION PERMIT Permit No. _2-f 2-0- -------------------------------- -------- ---- -------- ----------------- -- ---------------------- (Complete in Duplicate) Date Issued ............__-----_-------------------------------------- . 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 install the work herein described. his ap lication-is-made_in.,com lia e with County Ordinance No. 549. -,.—ti ---------- JOB ADDRESS AND OCATION- f --- Phone---------------------------- Owner's Name_____ _-_- _____-�___ � _______ _________ ----.. s �... � ----------- ------------------------ •------------------------------------.---I------- Address alell Contractor's Name--- -------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ C� Number of living units: -------- Number of bedrooms -------- Number of baths _ __ Lot size -------- ------------------------------- Water Supply: Public system ❑ Community system ❑ Private aDepth to Water Tabl -- Character of soil to a depth of 3 feet: Sand ®Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- r_--) No a New Construction: Yes E— No ❑ FHA/VA: Yes 'No [�I TYPE OF INSTALLATION AND SPECIFICATIONSi `+ f (No septic tank or cesspool permitted of public sewer is available within 200 feet.) Y f Septic Tank: Distance from nearest well--_3__8_-------Distance from foundation_10'-----------Material______________________-_--_______.______ 0__ No, of compartments...�-------------------Size---3 �1'-11........Liquid depth-----Y..................Capacity--1--- --- ----------�' p ^U Dis osal Field: Distance from nearest well.______f_______Distance from foundation..1u_.__----------Distance to nearest lot [eNumber of lines------- .------------__ Length of each line---f-Ut?'` ___ .....Width of french....Zr_�_______________________ Type of filter materia I___1_ J_ ------Depth of filter material____ -----------Total length_______ __ °:---__-_________-.____- Seepage Pit: Distance to nearest well.---------------------Distance from foundation_________-_-..__-__ Distance to nearest lot line_______________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------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 (describe):-------RV64--------- / r _ 4 ' -------------•----------------------- --------------------- --- --- 1►!1_PQ }--------- ------- T�------:�;F-tAM=RS--------- --.-._t4�dl ►.L, _Q j .: �--------r t_ s.1 '' - -- - , -------------------------------------------------------------------------- --------------- ------------------------ ------------ 'f° (-�_------------------------------------------------------------- I ----------- --- -- •- I hereby certify that I have prepareol°this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t e San Joaquin Local Health District. ./ Si ned ._ -----� - _--------------------------------------- -(Owner and/or Contractor] .. { 9 ) - ----------- L ,� By: (Title)- -------------- Y•----- -- (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 i APPLICATION ACCEPTED BY-------�'-R--a--- ------- ----------------- ---------------------------------------- DATE------ ------------------ REVIEWED BY------------------- --- a _ . . .DATE------- ------------ BUILDING PERMIT ISSUED------------------------------' -------------------------------------- DATE---------------------------- - - ------------------- - --------- Alterations and/or recommendations--------------- - - --- - ------ - ` ----------------- ----------------•--------•----------------- ------ - --------------------------------------- ---------•--••---•-------------------------------------------------- r I A ____________________t--_-_-___-_____-_-__.___-__._._______. .-.__ -_- _ -_--_-_--_-- ..-- -_ _ ___-_________. ____-.___ ____..._______..__._.-_____-.-.__-__-.____-__-._______.__...____.___________-.______.-___._ FINAL INSP 14.-- ' - - - - Date------ -- �� v� ---------------------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-CG.