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FOR OFFICE USE; ' 3 `I 3 G L/ ------------------ ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___, .....� 7 ----- ---- ---- (Complete in Duplicate) ------------------- Date Issued . -�Q-_�� ___ ____________ This Permit Ex�ires 1 Year From 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. 5xr49'. JOB ADDRESS AN�D� LOCATION_ ---------------- Owner's Name------G ----------IVI rJ { - ��l�T-fC�--- Phone-------------------------- Ad d ress--------------!� Contractor's Name---�� ---- -- ----------------------------------------------------------------------------- Installation will serve: Residence B- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , 'i Number of living units: __!____ Number of bedrooms _ ----- Number of baths Z....__ Lot size ___-P4_e_v_ _____.________________________________I Water Supply: Public system ❑ Community system ❑ Private P Depth to Water Table Y_a ft. I Character of soil to a depth of 3 feet: Sand I3`Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 'Hardpan [] Previous Application Made: (If yes,date---------____------_) No R- New Construction: Yes 0-- No ❑ FHA/VA: Yes R' No ❑i TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �e ` Material Septic Tank: Distance from nearest well__.1_.______..._Distance from foundation__-.t Q,-_--r--___ __------------------------- __.-_...__ ( No. of compartments__-___--- --------- -----Size--4�y}I'_g- 47___Liquid depth.......'-/---------------Capacity_.Zt°F + i Disposal Field; Distance from nearest well-J-6___-_Qistance from foundation___-�_q_r_.___Distance to nearest lot line---------------- Number --r -____Number of lines-------3--------------------------Length of each line_/0a-!/00_- CVidth of french.---z-_/.----------------------- 2 • Type of filter material___1R2�- Depth of filter material_-_-_�g_----._____.Total length___-- _`�a_�_________ _________� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_----------- I ❑ - Number of pits----------------------Lining material-----------------------Size: Diameter----------- --.- Depth_ 4" --Qe tn. Cesspool: Distance from nearest well-----------------Distance from foundation ------------ material_-__---______--_____.____._________� ' ❑ Size: Diameter---------------------------------Depth-------------- --------------------Liquid Capacity_------------ --- galsi Privy: Distance from nearest we]-------------------------------_-------------____Distance from nearest building--------------------------------.......... ❑ Distance to nearest lot line----------- ---------•--•---------- ----------------------------------------------------------------------------=-------------------- Remodeling and/or repairing (describe):--------------------- ---------------------------------------------- ----- ` -------------------------------- ------------------ ----------- -------------- f' ---------- ------------------------------------------------------------------------I---------------------------------------------------------------------------------- ------- fly ----------------- ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- 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. r �`__/i/_` (Signed)------�-t.3�� --- �-- - --- �-�- --�--- -� ----------------------------------- -------- - -- - -(Owner and/or Contractor -By: s .sem ti��----- "- -�=---------------------------•----------'�--�-'='---'{Title)-�'------��`-�-^ -- .-....-.._----�------- -"� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y_.- ______ DATE___s-------9------ -/�-.-._-__- -- REVIEWEDBY----- ------------------------------ - --- ------------ -------- DATE------------------- BUILDINGPERMIT ISSUED-------------------------------------------------- ------------------------------------------ -- DATE--------------------------------- -------------------------- Alterations and/or recommendations:------------------------ - --- -- - ----- - -----•--------------------------------------------------------------------------------------------------------- i ----------- ------------------—------—--------------------------------------------------------- ----------- --------------- —-------------------- ---------------------------------- -- - - ---- ------------------------------— ------------ ----------- ----------------------- -------- ----- .----.-.--.-.=-------------------------------- FINAL INSPECTION BY: -ts ---------------------- Date- 7 ---- ---- - - -- -------------------- 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 r.p.C�.