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01 FOR OFFICE USE: /Q GD _ eq k I APPLICATION FOR SANITATION :RMIT Permit No. ------------------------------------------------- •-e --------.----=---------------------- - - --- --- (Complete ;n,.Duplicate) Date Issued ............_---_--------_--------------------------------- 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 instal the work herein described. This application is made in compliance with County Ordinance No. 549. �r�o a � mac?.. �r�c�c--�• -� � / �I /l7( --� J JOB ADDRESS AND LOCATION.. iJg1t� 1,5--------------- d! �� 'la------- T Owner's Name- 1r------------------ -------------------------------- ------------------------------------------------------------- Phone:77 _SQZ/ . Address. ;? -------------------------- •----------------------------------------------------------------------------- Contractor's Name-----� - ---------------•------------------------------------------------._...----------- ;-------------•-------------- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other dila�' �P Number of living units: Number of bedrooms ........ Number of baths -------- Lot size ___________________________________________--____._.___--- Water Supply: Public system El Community system [I Private Depth to Water Table ---4.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'K Clay Adobe ❑ Hardpan ❑ Previous Application Made: (Hyes,late.......-------------) No New Construction: Yes No ❑ FHA/VA: Yes E] No ] TYPE OF INSTALLATION AND SPECIFICATIONS: ' l No~se tic tank or cess ool- ermitted,if ublic-sewer:is.available-within-200.#eet.] ,. Septic Tank: Distance from nearest well_.��_-__--_Distance from f undation___�&__________--Material_-�'a/,-�V ____________________ �� e No. of com artments______ _________________Size_____ ____._ _ Li'uiel de th r? _____..Capacity J Dispo al Field: Distance from nearest well---41®p------Distance from foundation.=�,`1-- r Distance to nearest lot lin ----------------- Number _____-____-.__Number of lines__:__Z------------------- _-_---Length of each line--------- ----___1....Width of trench--mmyy- .--------------_--,- Type of filter material.- Depth of filter material__ _____:._..Total length_____--r .__________.______ Seepage Pit: Distance to nearest well_______________=______Distance from,.foundation-------------'._,_.Distance to nearest lot line----------------- ❑ Number of pits_-'-------- - Lining materia1l-_.: = ._.Size: Diameter------ - -- _-- ---Depth--------------------------------- Cesspool: Distance from nearest well---------- Distance from fo'undatior--�-r---......Lining material_____________________________________. i _0. Size: Diameter.- --- -Depth - iquid Capaci#Y gals. . - ------ L 'Privy: Distance from nearest well-__---_----- ------------------ Distance from nearest building--_-_.-.--------.------------------_----- ❑ Distance fo nearest lot' lire-------- ------------------ -------------------•------------------------------------ --------------------------------------------- Remodeling and/or repairing (describe):-___ t •------•---------------------------- --------------------------------------------------------------i----- -------------------------•-- ----------------------------------------------------------------------------------------------------------- -------------- •--------- --•--------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance tate laws, and rules and regulations of the San Joaquin Locai Health District. Si ned _-- �-- _ _p /C.- --- -- ''------------------ ------------------------- - -.- (Owner,and/or Contractor) (Plot plan, showi g size o of, loc tion of system in relation to wells, buildings, etc., can be placed on reverse side). , E FOR DEPARTMENT USE ONLY DATE 7 : APPLICATION ACCEPTED BY ------------------ � .... -- "----------------- --------- �� ------------ REVIEWEDBY------------------------------------1- ---------------------------------------- DATE----------------------------- ------- BUILDING PERMIT ISSUED------------- I----- - --------------- DATE------------------------------------------------------------- Alterations and/or recommendations: 1 °"{Tal ._P?P6cn =`-�A►v--- -----------•-------------------------------------------------------------- ---------•- ------------------------- k ----•------•.----•-•------------------ --------------------- 21-F)f - ---------------_ ----------- FINAL INSPECTION B Z` /--6 AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,C{Ilifdrnia Lodi,California Manteca,California -. Tracy,California F-P.C O. -