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FOR OFFICE USE; 1� ---- -----------------------3 APPLICATION FOR SANITATION PERMIT Permit No. _. .. ��r-��1 (Complete in Duplicate) f Date Issued _!Il___-_4o -----------------------------------_. _._.------------- This Permit Expires 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 IINo. 549. JOB ADDRESS AND LOCATION----- `' 3-------- -------------------------------'------------------------------i------_-...... f ------------ Owner's Name--------dam-?� --`----------H C ' -------------•- •---- -------------=---------------------------------- -------------- Phone__1 o.-'7=�`'r� Address----------------........ ----. .1!t� ..--------------------------------------------------------------------------------------------•----------------------------------------------------------•- 1� .. Phone-- Contractor's Name = S --------- --•------r-- ! Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__L-_ Number of bedrooms __ _ Number of baths ___-L Lot size - ____X_1_f_0__i___________------------ Water ___. __Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table -.6-P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rj Hardpan ❑ Previous Application Made: (If yes,date___________ _____) No N New Construction: Yes ❑ No p]( FHA/VA: Yes ❑ No X 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-----------------Distance from foundation--------------------Material__________________________________-_-_______- ❑ No. of compartments-------------------------Size--------------------------------Liquid depth------------------ -------Capacity----------------------- r Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line..--------------- 0 ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ , Type of filter material----------------------.---Depth of filter material----__.---------------Total length---------------------------------------- Seepage Pit: Distance to nearest well--14DAE-__--Distance from foundation------1-0________-Distance to nearest lot line---�__------- 1d4 Number of pits-------)--------------Lining mater:al__2D�)C--_--Size: Diameter_-_-__3-6_n-------Depth........... -'___-______-_ Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material___-______________-____________-___. ❑ Size: Diameter------ ------ ------------------------Dep}h----------------------------------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------t--------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------/J+A— f------112----- -----------s -------•----- ---------------------------*--•--------------------------•-----------------------------•------------------------------------•----------------•------------------------------------------------•------------------------------- ------------------------------------ ------•-••-------------•-••---------------------------------------•--------••---•--------------------------------------------•------------------------- ----------------- 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, " �-�L ------------- '----- -- 1/s1--------%:G '4'4— ' (O ner and/or Contractor) (Signed)-------------- i sr-�•5,. ------------ -------------------- Title------------ -. - (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- --------------------------------------------------------- DATE---------,rte --(,. --------------- REVIEWEDBY------------------------------------------------------------------------------- --------------------------------------------- DATE -- ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ------------------------ DA-TE----------------.----------------------- Alterations and/or ecommendations----------------- -------- -------------------------------------- --• _.__-?r -___�3____________________-�. _ __. _ /; -----;____°_____________-____r�J-_______-____-__-_-___-_-________-____-____-_-_---__-_ ------------------------------9-:-- 3-------------X -------- ---- -- ----- ------- r' !�----------------------------- ---------•----------------------------------------------- --------------------------------------------------------- -------------------------------------------------------------------------- ---- --------------------- s F1NAL INSPECTION BY:...... _%-__�G4'-------------------------------------- Date........-5z--2>_-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REViSEO S-S9 3M 3-'63 F.P.CO.