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FOR OFFICE USE: a ---------------------------------------- --- ----------- e_ ----- ------------- IGJ __ ______________ _________________ APPLICATION FOR SANITATION PERMIT Permit No. ._,l...L- �.� - --- ----------------------------------- --------------- (Complete in Duplicate) ------- --- This Permit Expires 1 Year From Date Issued Date Issued _____9 � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described. This application is ade in compliance with County Ordinance No. 549. l potq JOB ADDRE,WAND Owner's Name-------------Ff:?0A-K----------- _ -------------------------------------------------------- Phone------------------------------------ j Address --------- -�-•f-----------RI_PION------------------------------------------------ Contractor's Name---pQ_tt�td.t.,t_1lE_ P7t - ------S�Rvj..C-R=—----------&Q.D Wone----------------------------------- Installation will serve: Residence gjj- apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: -t------ Number of bedrooms _3--- Number of baths _--_ Lot size ----9__.%__.......K_____�5 Water Supply: Public system ❑ Community system ❑ PrivateJ�T`Depth to Water Table /_'Z4t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ a Previous Application Made: {1f yes,date--------------------J No New Construction: Yes 0--No ❑ FHA/VA: Yes ❑ No Pr__ i TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�xsk: Distance from nearest well_____ __________ Distance from foundation----1_ ----------Material_�Q_�C�,_�'��------.. No. of compartments------"�-__________Size__/X10_-k_-5_--Liquid depth_____,,---_Capacity___. Disposal Field: Distance from nearest elf___,~._._Distance from foundation_� ----------__Distance to nearest lot ---------- Number Number of lines___.__ ___ _________________Length of each line__-f-_ -Q__.Width of french------- ______"'____-___ Type of filter material._RQ_ -----Depth of filter material___. Total length-----------`0Q-____f_______-____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material------_---------. -_Size: Diameter--------------.------ -Depth-------------------------------_• 1 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_-----------------------------_------ -- t ❑ Distance to nearest lot line---------------------------------- ------- Remodeling and/or repairing (describe):__S/:SM_M____� ` `1 L_ -____. Q----------- ----—------------------------------------------------------------------------------------------------------------------------------ -____ . ---------------------------------------------------------------------------------------------------------------------------------- ------ ----------------------------------------------------- ---------------------------------------- -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- I hereby 'fy that I IhAve pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and r fes n gulat' s of the San Joaquin Local Health District. (Sign ---- -- - ---- - ----------------------- --------------------------------------------------- ------------(Owner and/or Contractor) (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 4 APPLICATION ACCEPTED BY---- I--------------------------------------------- -------------- ------------------------- DATE_ REVIEWEDBY------------------------------------------- ------ --------------- --------------- ------------------------------------------ DATE-:-------------- ------------ ----------------------- BUILDING PERMIT ISSUED--------------------------------- - - ---- - ----- -------- ---------------- DATE ------------- Alterations and/or recommendations: _ --- � ---•- --- - - 15 DO ----------------------------------------------- ----•------ ---------------------.------------------------------------------------------------------------- ---------------------- --------------------------------------- FINAL INSP ON B '� Date - j .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.p.CO.