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FOROFFICE USE: ------------ --- _ �» --------------------------------------------- --- APPLICATION FOR SANITATION PERMIT Permit No. . ...... .. 3 -------------------------------------------------- (Complete in Duplicate) Date Issued �.:� .- t/ ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constru and install the work herein described. This application is made in compliance with County Ordinance No. 549. J B ADDRESS AND LOCATION----R OCATION----R ------ ------------------------------� -----------Q.st�-- C�q/— ----------------- ------R-d-i_-_-1p--- ---/- Owner's Name---Jah --------D ---Cc _*---------------- _-----------------------.------------------------------------------ Phone� /~S -�-------------- Address _ - _ Address---- _ # ---- - ------------------- Contractor's Name----s - --------------------------------------•-----••------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: __j---- Number of bedrooms __f.---- Number of baths -1----- Lot size __pp570�...�5,��------------------- Water Supply: Public system E] Community system E] Private Depth to Water Table _C1___ ft. al-0L Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan El Previous Application Made: (if yes,date-----------._._..__} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4� rr,,D�istance from foundation_.._W r_.__Material.... - ��im Septic Tank: Distance from nearest well�_ ^`-�7' _ __________________________ P -2-----------------Size--- X.S------------------Liquid depth-----yk2—-----------Capacity..I�' No. of cam artments___-- Disposal Field: Distance from nearest welld! '._Distance from foundation__l-0-----------Distance to nearest lot Number of lines-----------I_ ---------------------Length of each line------J-a----------------Width of trench----�---r---------------------- Type of filter material----.--------------------Depth of filter material-----------------------Total length______�p------- ____________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--------- 171 _______❑ Number of pits----------------------Lining material-----------------------Size: Diameter------.-------.--------Dept h-----------_--------.------------ Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material___________._____________.._________ [❑ Size: Diameter- --- --------------- ----------------Depth-------------------------------------- -------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buiiding------------------------------------------ 0 Distance to nearest lot line--- --------------------------------------- ------------------------------------------------- --------------------------------------------- Remodeling and/or repairing (describe):-- 1 G'-` ------------------•------------------------------------------------------------------------------------------------------------------ --------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta�.e laws, andWes id regulations of the San Joaquin Local Health District. (Signed)- /t ------------- ---------------------------------------------------------------------------------(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). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ---- - -- ---------------------------------------- DATE-------------------------------------------------------- REVIEWEDBY------------------------------------------ - ----- -------------------------- ---------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE--------------------------------- Alterations -------------------- ------------Alterations and/or recommendations:--- ---------- --- --- ---- - --------------- ----------.---------------- --------------------•----•-•-------------,--•-------- ------------------------------ -•-----------------------------------------------------------•-------------- - ---------------------------- ---------------------------------------------------------------------------------------------- ------ --------------------------------------------------------------------------- - ------ ------------------- ------- ------------------------------- -------------------------------------- ----------------------- ---------------- ------- ---- - ------- --- ----------- --------- ---------------------------------------------------------------------- ------------- ----------------- --- ----------------------- ------ FINAL INSPECTION BY:.'-------------- --------------- ------------- Date-- -r ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. _ _�