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FOR OFFICE LASE: APPLICATION NOR SANITATION PERMIT Permit No. ----------------------- --------------- --------- , ------------------------- ----------------------------- (Completelicate in Du Duplicate)) bate Issued -----_-__-_ ----------------------------------- --- This Permit Expires_I 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. 549. i� -- -� ` JOB ADDRESS AND L CATION---- -----�-`------ = •/ / 7 � � h Owner's Name---- ---- -- J-N-Ry--/----------Com_---------��A-y---- V.!• � ,d --------- Phone------------------------------------ ................ P--0-=---�p�..------` -7-�---------- LP[� -r ----------------------------------------------•-----------•----- 4 Contractor's Name-----6-VA) ----- ---------------- Phone----------------------------------- Installation of living units: ___�__�Number of bedrooms 3_._ Number of 'baths / 2-Lot size------0V ❑ether ❑ Installation will serve: Residence A artment House Commercial Trailer Court Motel O Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water TaUe I_ ft. Character of soil to a depth of 3 feet: Sand p--'Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [j Hardpan E]Previous Application Made: {If yes,date----.------.-------.l No�]/New Construction: Yes No E] FHA/VA: Yes 0—'No El T-YPE-PEINSTALLATION,AND.,SPECJF-ICATION5:_.—r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__-50---Distance from foundation----l0-------.Materia ... C11 ��___._- � � N No. of compartments._._._ --------__._Size---YA_I-Q-�_5 Liquid depth----- _..�__-.-.__Capacity_/ '�--___.___ Disposal Field: Distance from nearest well.,�'� ---Distance from foundation----f --------Distance to nearest lot line t-5 Number of lines----------2..------------------Length of each line---V$_.°t_-'7 -.Width of trench.___..__------_ Type of filter material __130 -K-e_Depth of filter material-----/�____---_-.Total length_________________________ Seepage Pit: Distance to nearest well--------------- --Distance from foundation--------------------Distance to nearest lot line__.___..____--.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------.-------------- ' Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material-----------.-------------------.____-- ❑ Size: Diameter---------------- --------.Depth------------------------------- --------------------Liquid Capacity - -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------_---_________-.-_. ❑ Distance to nearest lot line---------------------------- ---- ------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):--------- -------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------ ----------- --------------- ----------------------------------------------------------------------------------------•--------------- --------------------------------------------------------------- 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. ----- ------------------------------------------{Owner and/or Contractor) (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 BY--..----'-- -- --------------------__---_._ DATE /- - ---'--------------- REVIEWEDBY---------------------------------------------------------- ------- ---------------------------------------------------------- DATE-------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------------------------------------- DATE-------------------------- ---------------------------------- Alterations and/or recommendations:-------------- --- ------- ---------------------------------------------------------------------------•-------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------•--------------------- ------------------_----------------------------------------------------------- --------------------- -----------------------------•-------------------------- ----- -------------------- -------------------------------------------------------------- ------------------ --------------------------------- -----•--•--------------------- ----- / :- l� r ----------------- - - ----- -------------------------------- ------'f ' v J FINAL INSPECTION BY:- Date '^ . . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street T24 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 C.