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FOR OFFK-E USB: ------------ ------ --------- --------------- -.--- 9 f APPLICATION FOR SANITATION PERMIT Permit No. . ! !---1- ---------------- --------- - ------ (Complete-in Duplicate) Date Issued -- ----------------- This Permit Expires 1 Year From Date Issued Q� 1 60—O�' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T��hyyis application.is made,in—complia ce with County Ordinance No. 549. LATH RO P JOB ADDRESS AND LOCATIO C- ----------- � h--NL /Q_i>JJ J �,'7 Owner's Name---------------PF(__5C-1--L J4-------- F ------- ------ Afj c Address.- ,1 :.. ��► _._.- _111 LE -..->l- —L��-------- T ---� ---------- -------- ---------------------------------- Contractor's Name----CftRC_L9�- ---- ----------------------------------------------- Phone.-----.---------._------•-------- Installation will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I ' Number of living units: ]----- Number of bedrooms _._ Number of aths ._1--__ Lot size _.__/5,coo- 4 Water Supply: Public system E] Community system El Private Depth to Water Table ..P..- _ ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_............... . No�New Construction: Yes ❑ No e9--FOIA/VA: Yes ❑ No D _ 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 depth--------- ------- --------Capacity----- ------ O Disposal Field: Distance from nearest well.__�P....Distance from foundation--- ___----------Distance to nearest lot line----- __ L� ___---Len Length of each line__ _--- .- r Width of trench_..___ _-k �ST1/�G Number of lines.---- ---�:-------- -� �-- 9 �'�-- --;�----- � -�----------------- T e of filter material_ O C K-----Depth of filter material------.�_p_._-_-.._Total length..-_.--_-_t�2_fJ------------------------ � Pr D� YP ,f�- -- -�- 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 (describej-......... ------------ --------- ------------------------- -----• ----- ------------------------------------- --------------------------------------------------------------------------------------------- --- ---- ------------------------------------------------------------------------------------------------------------------------------------ --- - ;------------ -- ------------------------------------------------------------------------ ---------------------------------- ------------------------------------------------------------- I hereby certify that I have repaired this application and that +he work will be done in accordance with San Joaquin County ordinances, Stat laws, and u es an egulations of the San Joaquin Local Health District. ------------------- ---- ----------------- ----(Ow and/or tory (Signed) xis? G �'z` `? - (Owner Contractor) -- -------------- ----....----- - - --- ----------- ------------ - ------ (Plot plan, showing size of lot, to ion of system in-relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1---L `O'--- ---------------- DATE REVIEWEDBY----------------------------------------- - - ----------- --- ----------- ---------------------------------- - DATE BUILDINGPERMIT ISSUED-------- -- ----------------------------------- ------------------------------------- ---------------- DATE--------------------------- -- --------------------- ------- `Alterations and/or recommendations----------- ---- - --- ------------------- ---- ----------- -------------------------------------------------------------------------------------------- ------------- ------------ -- ------ -------- ------ --- ------------------ ---- ---- ..---.... jj--- .. --- ---- - ------- Date---- / �� r FINAL INSPECTION BY:_ �� 1b------------------ ---- V- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazellon Ave. 300 West Oak Street 124 Sycamore Street 20,5 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H-9 2M 1-67 Vanguard Press �'