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FOR OFFICE USE: �- ----------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ✓��. _� ------------I--------------- ------------ -- ------------ (Complete 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. .f/ d_ JOB ADDRESS A LOCATION----/- -�-----c�---------� ell/-------�--�- � � - r f ----------------- Owner's Name----- ba K-Ik-- ' 1 '' 1 i -- ---- -- ------------- ---------------- -------------- Phone---------------------- Address------------ Contractor's Name______ ._ _ Phone ,� ,�� , ------------------------ ------------------------------------ Installation will serve. Residence [$f Apartment House I] Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: _ -. Number of bedrooms _ -- Number of baths -)----- Lot size _-A_C-FN_lai _f - ------------_------__ �1 Water Supply: Public system ❑ Community syste ❑ Private g4o'15epth to Water Table lt. Character of soil to a depth of 3 feet: Sand4er Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (!f yes,date___________ --------) No 93-'--New Construction: Yes ❑ No P--FHA/VA: Yes ❑ 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------------.-------Material--------------- --------------------------------- El No. of compartments----- - ------------------Size---------------------------- ---Liquid depth------------------------Capacity-------------------Disposal Field: Distance from nearest well....--_.-..-_---Distance from foundation--------------------Distance to nearest lot line--____---__- IFA* ! � - Number of lines--------------�..I'__.------Length of each line--------R0---_j�___.Width of french.-__.--` � Type of filter material-__ ��---_-___De th of filter material---_._ _ _-___--.Total length-_____----- ____�_.----__--Seepage Pit: Distance to nearest well-.-n_2--.-._-_Distance from foundation----/0----_-_.Distance to nearest lot line_ Number of pits---.----/.----------Lining material--FO C- Size: Dia meter--lQ_-__x___1_�_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 buJ&n ------------------------------------------ Cl Distance to nearest lot line_________________________ Remodeling and/or repairing fid;? t ------Z-e-w f ----------1 r-�c_ v=t1 ---f-----7`Mj;5----- �4 _Q a41 ----------------------------------------------- - ----------`i r_-c'? --------------------------- ----- ----------------------------------------------------------------------------------------------------------r----------------- ----------------- ------- 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 an regulations of the San Joaquin Local Health District. (Signed)•--- -(n_A - -------------- --- --(Owner and/or Contractor) By: ----------•--`--------------------------------------- -- - ------ ------ - --------t_,_K-C2----(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 BY------ , ----------------------------- ----------------------------------- DATE---------- ." _�...^_ ... REVIEWED BY--------------------------------------------- -- DATE ----------------------------- ---------------- UlLDING PERMIT ISSUED --------- -- ------------------ DA-TE ------------------------------ -------------A terations and/or recommendations:. - --------------------------------------- ---------------------------------------------------- --------------------------------- FINAL lNSPECT'ON_-BY - Date--- - - ----------- E.-_ i`{ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th street f Stockton,California Lodi,California Manteca,California Tracy,California I F,P.0 1]. t 1