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FOR OFFICE USE: f .�1 � ' I --_-----.Il--.v -------_ APPLICATION FOR SANITATION PERMIT Permit No. -___ __ --------------------------------------------------- -- (Complete in Duplicate) -------------------------------I---.----.--- This Permit Expires.I Ye9E From Date Issued Date Issued --. ------- . 6 S Application is hereby made to the San Joaquin Local Health District'for a permit to construct and install the.wor herein described. This application is made in compliance with County Ordinance No. 549. Aj._Pe JOB ADDRESS ANDLOCATION. �x �1 . .rz. �� ---------------- Owner's Name --------- •~ ----•------- .s- �_... Phone_.. " f f- . Address-----------------Z,7_1 -?......e----- � j 1 Contractor's Name--- _ . Phone `s -f L--tel__-.._ Installation will serve: Residence [ Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __._ Number of bedrooms J---- Number of baths __Z..__ Lot size -----1_7-_ -._Z_0 0_r____._ Water Supply: Publiclsystem ❑ Community system ❑ Private ®` Depth to Water Table 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--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ["No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) e Septic Tank: Distance from nearest well_.. 0__--- _Distance from foundation-----/_��__-_____. ---_________________ (0 No. of compartments_ -_-.._2-______________Size-_z�_`5C-&`b''XiLA`Liquid depth___118.-__..______--Capacity__ZA&C Disposal Field: Distance from nearest well_-4'a--------Distance from foundation_Yc-------------Distance to nearest lot line--- -----____-__-� Number of lines----------Y-.----------------------Length of each line__ _c +`_,r`4..__.__.Width of french-----�J------------------------ 1� Type of filter material----/7"A----.._Depth of filter material_._ length--------/_C_C---__________________ Seepage Pit: Distance to nearest well-__`_e_�_r._______Distance from foundation____- _4`__�_____.Distance to nearest lot line------ N Number of pits-------- n ___.___.___Lining mateal---11A�_A_-__-Size: Diameter._.33..`x-IW`__Depth----- ____________.___ 4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------._-______________.__. 'I }'f, ❑ She--Zameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------- -------------gals. Privy- Distance from n st we]-------------------------------------------------Distance from nearest building------------ ----------------------------- Distance to nearest lot in - ----------- ------------ --- ---------- - ----------------------- --------------------------*-------------- ----------------------------- Remodeling and/or repairing (describe):--------- -------------- ----------------- ----------------------------------------------------------------------------- ----------------------- = - ------------------------------------------------------- ---- ---- --- ------------------------------------------- -- ------ ---------------•-------------------------- - ------`-`-------------------------------------------------------------- 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 rules aed regulations of the San Joaquin Local Health District. (Signed] j �L =--------------------------I----------------------------I----------------------(Owner and/or Contractor) � q f ,...P 1 Ti (Piot plan, showing size-of lot, location of system to relation to wells, buildings, etc., can be placed on reverse side]. ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-[ ------ ----- ti=-=------------------------------- ----- DATE----------- ..- --- -------- -------------- f i DATE . REVIEWED BY `-------------- ------- ---------- ----------------------------------- --------- ---------------- BUILDING PERMIT ISSUED-------i ; "Y :___ DATE----------------------- ------ --------- -------- Alterations and/or recommendations•_..__'"" ------------------ `--- .`--t .------ - -- - ------------ --------------------- ------------------------------------------------------------------- r -------- -------- r --------------------------------- ---- --- - - ---- ------- ------- --- ----------------------------------------- ----------------------------------------------- ---------- ---------- -- v - . J, -_ la/� ,�-r'� FINAL INSPECTION BY:- "' - VNJOAQUIN =L� Date-------------------- �� ----- --------- E LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 3Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.Gu. - - 4