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�� rnLt not /' !� ---- --------- --- ........011 ----- APPLICATION FOR SANITATION PERMIT Permit No. ..f-� ... --------------------------- ------------------- ----- (Complete in Duplicate) 3�?��6 --------.--. This Permit Expires 1 Year From Date Issued Date Issued .__ _ _.��__.____ _.___ Application is hereby made to the San Joaquin Local Health District forr a,.permit to construct and install the work'herein described. This application is made in compliance.. it. County Ordinance No. 549. ,4,, JOB ADDRESS AND LO TION `,__a 77 ----------- -� �= ------" /7f`030 '-43 ----- ----- - ----------------- Owner's Name------------ '_.,-------- t — -- - ------ - Phone--- ----------- Address- lS� 2 - r ------------- ------------- .` - -- ------ _ --- ------------ •-- ----------- ----------------- Contractor's Name _ � Z , --------- ----- 1 ------- Phone- - -------------------------------------- Installation will serve. Residence Iq'' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: _L---- Number of bedrooms -, Number of baths __ -- Lot size __ -.-- _ c�--- -----------------_-------__ Water Supply: Publicssystem ❑ Community system ❑ Private [R}- Depth to Water Table 4.v" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam E] Clay E] Adobe K- Hardpan ❑ r,, Previous Application Made: (If yes,date`__--._____________ ) No 2--__New�-Construction: Yes E!I'No ❑ FHA/VA:Yes c[ No ElW TYPE OF INSTALLATION AND SPECIFICATIONS: R' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_:2'_�_�_----Distance from foundation___lr._ ........Material__i�_1_14(et%��-------------- No. of compartments_________ _____.___-____Size__y3_=X _X _._ Liquid depth-___.�.- -_ Capacity___YQ / r Disposal Field: Distance from nearest weIL-4� P-_____Distance from foundationla----------Distance to nearest lot line__._`_-r___._. d Number of lines--------------------------------Length of each line-------Z.' ------------Width of trench.--z. ------------------- / Type of filter material-------- _c2G --Depth of filter material____--/�".____Total length_______--_�5� --_-----_- -----_ 7 Seepage Pit: Distance to nearest well___-Q_0..--___-_Distance from foundation___1_#-- _.____.Distance to nearest lot line_..-. ---___.._ i p �•s Num6er of pits------7-,.-----------Lining materiai----�,v_�.�.__.Size: Diameter---, -F'.--------Depth----I�------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-i._--------------.Lining material-------------------------------------- Size: -_-----_________--- .._______ __.Size: Diameter-------------------- O ------- ---------=Depth- ------------------------------="'--- - - -------Liquid Capacity----- -------------------gals. h Privy: Distance from nearest welt_._- --_______-_Distance from nearest buildin ]p g V� ❑ �Dls Barest lot line______________________ --��` ---------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): _ _ ------ --------I-•-------------------------------------------------------- -----------------------------•---------------------------------------------------------------------------- - u "4-- -----------------------•--- - -------------------------- -------------- =-----------------------------------------------•------------------------ ------------------------------------------------------------------------ ----------------------- i I hereby certify that 1 have prepared this application and'that the work w'iil'be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) = • •-r r--- - = (Owner and/or Contractor) - -- --------- ------------------------- By: --`- •------- -- - ----------------------- ---------------------------------------------------------(Tif le)--------- - ---- ------------.------------------------- - --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY --------------------------------- APPLICATION ACCEPTED BY--" ----------------- REVIEWED BY-------- � { = DATE - ----------------------------------------------------------------------- -- ------------------------------ ------------------------- BUILDING PERMIT ISSUED------------------- 3---------------------------------------------------------------------- --------- DATE Alterations and/or recommenda ions:___'"------------- ------------- - ------------� ------ -_ - f /�' G s' -� - --- ------ ------------------------------------------------------------------------------------- --------------- ---------------------------------------------------------------- ----- ------------------------------------------ ------------------------ ----------------------------------------------------------------------------- --- -------------------- -------- FINAL INSPECTION -�.-_-- Date-----7=z —4 - 'kk'-SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street, 124 Sycamore Street 205 West 9th street Stockton,California "' Iodi,California Manteca,California Tracy,California r.P.Ca. `�