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FOR OFFICE USE: f � APPLICATION FOR SANITATION PERMIT Permit No_ _______ _________ ------------------------------------------ -------------- (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. JOB ADDRESS AND LO ATION-------- 4_C'fL. I17C�_ P _ a �': '_ ', V- L f /, ----------- Owner's Name----•lT�--•----.�fr�.e�-•-=�.�••-•----��iPJ'�--��------------------------------ -- ------------------------------------ Phone-------------------•--••- Address--------- 1 ..---z`•-= ��x--------7� S.Cf -L4 _ _ ----� ------------------------------------------- ------- Contractor's Name._.> /T�i--.�Tl -------- Installation -----4.Q Phone �j7 - f� �a Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --__.l�__Gr �---------------------- Water Supply: Public system ❑ Coma unity system ❑ Private (4 Depth to Water Table _Ad_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [4 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote•-------------------) 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.) Septic Tank: Distance from nearest well--__^----._-Distance from foundation---—-----------Material-----_-.---__�_.-----------------------_--_-. ❑ No. of compartments------- ---------`-Size----------------- ------------Liquid dep h--------------------Capacity------- ------J-- Disposal Field: Distance from nearest well._�Q____Distance from foundati n...Zd.._ Dist nce to nearest lot line�_--__--- ❑ Number of lines- - --------------------Length of each line_- ____-_-/��__.- idth of french-------��{_ __---------_---. Type of filter material------Ph-_G°_e....Depth of filter material_._Z�____-__-___Total length------ls�Q------------------------� Seepage Pit: Distance to nearest well----------------------Distan.ce from foundation_�__----._-._-_.Distance to nearest lot line--.----_----_-.-_ ❑ Number of pits----------------------Lining material:---------------------Size: Diameter----.-----------------Depth----------------- _____.___.____-- Y Cesspool: Distance from nearest well-----------------Distance from foundation...________-_----_.Lining ❑ _ _ } � wmarter�ial_ -.-----____----------------_ ❑ Size: Diameter--------------------------------------De the�-', •- ---- -- -; ----Li Liquid Capacity- -----------------------_-_-_ga._l_s Privy: - Distance from nearest well --_. _ -.-.- _--__ E _ _ __--_________.______.____-___ Distance to nearest lot line--__� ___.�._ "7 _.. m Remodeling and/or repairing (describe)=-------------.. e't! -Z:5q`--- _ CJ--:_-f_ Ie - =4 _. ', f1f r•----------------------------------------------1---------------- -------------------------------- ----------------------------- REr►-rr�� N_ � F---meq------ A'` pN.? ------------------------- t' P1 ----------------1r------ -- .l f TA_�-4- F _ 3 L 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) t/�_� � ------------------------------(Owner and/or Contractor) By=--------- - - ----- ----- -- -----------------------(Titley_-&�L�� /�Iv_---��' (Plot plan, showing size of to ocation of system in relation to wells, buildings, etc., can be placed on reverse side). Y � - - FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY- -----F 1- ' 0-' ---------------------------------=_ = - ---------------------- DATE------- - a� -G --------------- REVIEWED BY----------------------------------- ----------•----------- --------------------------------------------- DATE----------------------------- . ------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------•------------------------------------------- - ------ DATE------------------------------------------------------------- Alterations and/or recommendations--------------- ---------- ------ ----------------------.:..----�----------- --------------------------------------------------------------.-------=- -------------------------------------------------------------------- ----------..--------------------------------- -------------=-------•-- - •-------------- [ -----------------------------------•- --------------------------- - -------------------------- --- FINAL INSPECTI ifl� _. Date _.' C! - ------------------------- SAN.JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 31A 3-163 F.P.CO.