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F R OFFICE USE: 1 — J / ` a ° APPLICATION FOR SANITATION PERMIT Permit No. ./.�� !- -- -- -- _ (Complete in Duplicate) - ----- --------�----- - Date Issued --------�-�I-1.-�- This Permit Expires 1 Year From Date Issued I 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 LOCATION _ ----- - -ML�- �---------------- ------------------ Owner's Name..- 4 V � i �_ l_ ------------------ Phone�7� Address------------------------51. _z - ---------- 2 '0 K-6 f ¢ Contractor's Name---------------------�Iir_ - _-...0 --------------- 1 ----------------------------••--------------•---........ Phone__ �J--IGS-- -3i-3� Installation will serve: Residence Uj--Apartment House ❑ Commercial ❑ Trailer Court ❑ iiMotel ❑ !! Other ❑ Number of living units: -------- Number of bedrooms - - Number of baths -------- Lot size --------------------- Water Supply: Public system Eo--C—ommunity system ElPrivate E] Depth to Water Table q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,( Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date.......... ) Nox New Construction: Yes ❑ No>QFHA/VA: Yes ❑ NOS TYPE OF INSTALLATION AND SPECIFICATIONS: ��ll (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----------------------- Disposal Field: Distance from nearest well__'___Distance from foundation....j__b�Distance to nearest lot Number of lines-------------- _Length of each line--- 7 ,57— -of trench.___ _4�_r/._._.______. e th of filter material-___-___ Total length__.-._....!_�-------------------- Type of filter material--�_ � p �-C�------- � J 1. Seepage Pit: Distance to nearest well------ -----------Distance f om foundation__ Distance to nearest lot Number of pits----------t- ------Lining material__ ize: Diameter------- Depth_. ------------- -� Cesspool: Distance from nearest well-------------....Distance from foundation--------------------Lining material-------------------.--------.---_____. ❑ Size: Diameter-------------------------- -- -- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals, N Privy: Distance from nearest well_______-----__-----------------------------.-----Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remocl4ingand/or repairing (describe):-------- --------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------•-------------------------------------------------------------------- ------------------------------------------------------------------------------------------=--------------------- ------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- 0 1 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 rulesja ulations of the San Joaquin Local Health District.(Signed)----------------------------•------------- ----------------- - r ------------------- ---------- (Ow er and/or ontractor) By: ..._.....�- ------------(Title) (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 APPLICATION ACCEPTED B . .......... = ."-�:_----- ---------------------------- DATE--------- r REVIEWED BY- ----------------------- --- � DATE -------------- - BUILDINGPERMIT ISSUED------------------------------------------------------ ------------------------------- DATE------------------------------------- - - ------------------ Alterations and/or recommendations:---- - ��'4 ` �� til L" 4--------------------------------------------------------------- ------------------------------- -- ----------------------------------------------- ---------- ------------------------------------- -- -----------__- ------------------------------ ------ -- ---------------------------- " ------------------------------- - ------ - ----------------------------------------------- ------- -------------------------------------------------------------------------------- -- ----------------- FINAL INSPECTION BY:. ' Date.- ---- 7 � - ---------------- � ..._._ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.