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FOR OFFICE USE: a — ---------------------- ------------------------=-------- ------- ----------------- --- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,P_4� ----------------------------- ------ ----------------- (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 wifih County Ordinance N-:.549. .` .:. OB ADDRESS ANW. . ATION _---- ` -------------nl3�u-o•�--- 47,6a _ 1 Owners Name . - - - `~��--- -- -- L--------------------•- ----- ----------- -------------- ---------- - Phone----------•------------------------- Addres--------- Contractor's Name__etZ . G Q ------ --------------------------=------------------------==-- Phone-----•-•---•-------------- - t d�' _ Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: = - Number of bedrooms 4r o_ Number -baths _`,. __ Lot size ____ :,et ,�'----------------------- Water Supply: Public system F] Community system E] Private De; clay t Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes date______.__..,__.___-) No E] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic Tank:t Distance from nearest well________________Distance from foundation_______=___.__.__.- Material---------- ' V3 ❑ No. of compartments - Size__'_-------------------- Liquid depth_ = Capacity - ~ Dispos laid: Distance from nearest well___�Q_�-°:_._Distance from foundation_;_ ------ Distance to nearest lot line__S_�______. Number of lines ------ Length of each line_ � ,��fW;dth otrench �-------------------------- Type or filter material.___--- c_ _+ ,-Depth of filter material----_T_ '_"-----__Total length_-_- _ __.__----_-__-__--_'' Seepage Pit: Distance to nearest well _________ ____ Distance from foundation___.____ ________.Distance to nearest lot line_______-______--- [] Number of pits-- -----------Lining material-------------- ---=----Size: Diameter-----=---- ----Depth-- -----------------------------APP Cesspool: r. Distance from nearest well-----------------Distance from foundation___-.--- ---------Lining material_._.__--_____...-'_ p t - ❑ Size: Diameter. ------------- ----------------Depth------------ ------------------- -------------------Liquid Capacity----------- -------gals, I Privy: Distance from nearest well__________________ --------------------- _Distance from nearest❑ buildin ------- G ----------------------------- Distance to nearest lot line__.__________________-.____. ------------------------------------------------------------------------------------- ( Remodeling and/or repairing (describe): -__.____ I ____ _______ ____' --_- -----n-- ----------------------I _ I - - ----------- ------- -------------------------------------- I here6y certif that I have prepared.this application and that the work will be done in accordance with San Joaquin County 414, ordinances, Stat a and rules and-regulations of the San Joaquin Local Health District. r (Si ned 9 } ----------------- ---- --- ------------------------------------ -------------------------- ------ ilnd/or Contractor) gY ----------••------ ---- ---- ----•• - -- ---- - -- -----------------------------•--------------�----- - (Title)------ ----------- --------------- -------- Q ', (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k t K FOR`DEPARTMENT USE ONLY �v d . APPLICATION ACCEPTED 8Y __ DATE___ --------------------- ----- - ----------•-_ REVIEWED :BY ---------- ' �- - ------------------------------- DATE------ --- BUILDING # _ r .F DATE -----------------F------------------------------------ 0 . ::, -------- PERMIT ISSUED------------------------------------ -----�------r-`-� --- ----- s Alterations and/or recommendatins:-----------------------------* __ T ------ -------------------------------•-------------------------------------------------- F y ___________________________________________________ Iw _ __-__-_--________-------------------------------------------------------- _____ _ '- ------------------------------------___-----____ A ________________________ ___ ________________________________._._. ______.____-_______-_--_____.----__-__ ________________-__ F€NAL INSPECTION BY:_---------.-- :r -- --------- 'Date-------'Z'- MN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 1 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California t F.RCO. t