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FUR OFFICE USE: - -------------------- -------------------- ------------- v� ...---------------- ..____._____.__,l__.__.__�____ APPLICATION FOR SANITATION PERMIT _ Permit No. .,S6e' -- ----- ---------------------- ------------------------- (Complete in Duplicate) ------------- -- ---- -------------------- This Permit Expires 1 Year From Date Issued Date issued _l.--r "/_-�,� 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__._ _ ----- <1 "O _ Owner's Name---------T--------- ;----•------------------------------------ -- ------ Phone---•--------- ----------- Address...... - -------------------•---------------------••s -------------------- - -----------------------------------------------------------------------•--------•----------------------- Contractor's Name `"(--C- ---Q---cs !!�K--------------------------------- ----------------- Phone----------------------------------- Installation •------------•---- -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ Number of bedrooms -___Number of baths ---(--_ Lot size _ --- ---------------------------------- Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table 7;�ft. Character of soil to a depth of 3 fe 6f: Sand g Gravel [+} Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dpte____--------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septi Tank: Distance from nearest well--- ---- Distance from fou dation__?--_____.Mat Lal__ .________.__..___._-.________._.. No. of compartments----2---------------Size--- ---'�-sx _---Liquid depth----- ' ---------Capacity_.! ____ --4 Disposal Field: Distance from nearest well..._ C' Distance from foundation-----� --- _._..Distance to nearest lot line--- I Number of lines-------�--------------------Length of each line-------&0_'__.----_ ----Width of trench---- -------------_ -=------- Type of filter material_-- ------Depth of filter material----11-----------Total length---------/- �------------------ D 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------------------------- ._ s ❑ Size: Diameter-- I---------- ----------------------Depth------------------------------- - ------------------Liquid Capacity------ -------------------gals. Privy: Distance from nearest well_----------------------------------------------Distance from nearest building----------------__--_._______ ❑ Distanceto nearest lot line-- ------------------------------ -------- --------------------- = -------------------------------------------------- Remodeling and/or repairing (describe):_ y v� F -- - - ---- -------------------------------------- ---------------------------------------------------------------I--------------------- --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------~---------------------- 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)_:�n__7/� ?ne S dilt-0- --------- �---------------- - ----------- ---------------- - --------- -------(Owner and/or Contractor) BY ------------------------------- I-------------------------------------------------------------------------------------(Titlep (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be laced on reverse side). t ••i ( FT DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- REVIEWED Y * f - DATE_.---l_-_ �'� �� ' ---------------------- - - ----- REVIEWEDBY - --------------------------------------- ------------------------ DATE BUILDING PERMIT ISSUED--------------- ------------------------ Alterations and/or recommendations:I--- ------ ------------------ ---------------------•-•-•-----------------------------•------------- ._...-------••----------- --------------------------- a ----------------------------------------- ----------------------- - ------ ------ --------------------------------- -------------------------------------------------------------•--------------------------•------------------- r-----------------------------------------...----------------------------------'------------------------------------------------------- --------------------------------------------------- -------------- .._ _-..--'----._..------------------------------ ------------------ -- yT FINAL ..;!}NSPECTION BY _.. - --------------------- ------------------ Date---------` ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California r} *Manteca,California Tracy,California F.P.CC. _►h I