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FOR OFFICE USE: lvgiF I - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.�l. - -- ----------------- - -- - ------ ----- (Complete in Duplicate) r _ ____________________---__________________r:____..___..__. This Permit Expires 1 Year From Date Issued Date Issued M3 — 3va-2-3 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 CATI N- (( � -_-.-`-=—""=IJL ---------- -------------- -a ------------ -- � --C1�_----f P Owner's Name --------------- ------------------------------ ------------------------ Phone--- -.------------------------------ Address..................... .rTx-._ ........... _ - . ------ -Contractor's Name--------- - __-{_ __. �� _.__ Phone ___ _ rC .9 Installation will serve: Residence [ Apartment House [] Commercial ❑ Trailer Court ❑ Motel [] Other F1 Number of living units: __f.._ Number of bedrooms __J_ Number of baths --_./_ Lot size -----------5;V-_&-. +575----------------- Water SuPPIY� Publics stem Community system El Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam Q Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {1f yes,date------ -----------I 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---- _1- -__Distance from foundation----/L.!__---___.Material---..-__ No. of compartments_.-___�---------------Size------- - �_,�___.._.___Liquid depth--------_ _. _ ____Capacity--fQ�+or✓�� - ---- ,• f �. Disposal Field: Distance from nearest well _�_. .....Distance from foundation___ ___-._.__.Distance to nearest lot line_____r ----- Number of lines--------.7---- .- Length of each line------------------------------Width of trench-_----- ----------------- Type of filter material---------_---------------Depth-of filter material-----------------------Total length___-___-__.-_--_____-._____-----__.-____-. rn P Seepage Pit: Distance to nearest well-._------------------Distance from foundation--------------------Distance to nearest lot line-----._-------_-_ ❑ Number of pits----------------------Lining material-----------------------Size: Dianneter--------------.-------- Dept h..........-.--------------------- Cesspool: --------.------- --Cesspool: Distance from nearest well-----------------Distance from foundation.-.----------------lining material--.--..________.___.._.._____._______ q ❑ Size: Diameter-----------------------------' Depth--------------------- Liquid Capacity gals. Privy: Distance from nearest we]L.-.____{________________________-.-.-.---------Distance from nearest building-_______________-_______---_--__._._____. ❑ Distance to nearest lot/line ----- ----__---- 'y Remodeling and/or repairing (describe}:_IQQ__� _ ---± J_._s /_� Lcx-__ Q-`4---t� _r G'�' ----------------------------------------------------=------------------------------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. s. (Signed)--------------------- ---------------------------------- ------------------------------------------------------------- ------(Owner and/or Contractor) By: � ------------------------------------------ rile ._.--...----.. . F } (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 D •2b - APPLICATION ACCEPTED 8Y '@ - DATE. ----------------------- REVIEWEDBY--------------------------------------------- ------ DATE---.-------------------------------------------------------- BUILDING PERmIT ISSUED-------------- ---- ----- -- .-------------- ------- DATE-- Alterations and/or recomendations:_ .iO1.:---- �?Q _�yt4C� ------�-_' '.----.------------------------------------------------ --------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- ---------- -------------------------------- ---------------------------------------------------- ------------------------------------------------- - ------------------------------ ------------ ---------- -------•--------------------------------------------------------------------=`--------------------------------- ----------------------- ------ FINAL INSPECTION BY:.e7 Date......!. ... _ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California