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I-UK QI-FICE-USE: ,. -----------------------------_-- ---------------------- ______________ APPLICATION FOR SANITATION PERMIT Permit No, __f_f __--•- - (Complete in Duplicate) -------- This Permit Expires 1 Year From Date Issued 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 a plication is made in com liance with County Ordinance No. 549, }� �4✓�' JOB ADDRESS AND LOCATION... 84 -L Q- � �' S�� .�-' - .`I/i ---- /� - Owner's Name-- -tl_ y ` �� _C �l ' `�-1`-±r .S --------------- Phone--------------------• - Address----------�J_5r-- - ----- -------- •lru---,dD f. ----------------------------- ------------------------------------------------------------- -----------------------------•----------------- Contractor's Name...... •----------- _ , ------------------ Phone--'- - _ Insfallafion will serve: Residence Eb- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r� Number of living units: -1----- Number of bedrooms J____ Number of baths -1----- Lot size ____-___I _,/,r- _-______________ Water Supply: Public system Community system ❑ 'Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand El"-Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------- ------) No ®- New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE-OF-INSTALLATION ANDTSPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-WO--------Distance from foundation----1_a_ ______.Material .__/Qed.LR/-0-V_�_--kt� No. of compartments- -----P.- ------ - ---Size---.4fir-pll__` ------Liquid depth------- Capacity__�'cDisposal Field: Distance from nearest well.-/I✓z----_-__Distance from foundation___04_-_--____-Distance to nearest lot line__ (� ®� Number of-lines----------Z- of each line____L/-(-.f-----------------Width of trench___-„�-r __ ___ vU Type of filter material-__a�oL-/�----_Depth of filter materiel__--_/r _ Total length �lv __ -__ ______ _--- , ------ Seepage Pit: Distance to nearest wel�`----Distance from foundation__'”-_____ Distance to nearest lot line_- - e. i Number of pits----------------------Lining material-----------------------Size: Diameter----------------------- Depth-....... __------------------- lop,Cesspool: Dis a from nearest well-________________Distance from foundation.---_-________-----.Lining materiaf__---_______-__--_-___.._ . ' s :,�w". ..., �....._. -------- ❑ Size: Dlame t- ---- ----------- Depth_ -= )------- I----- ----------------------Liquid Capacity- gals Privy: Distance from; nearest we ____ Distance from nearest buildingd t --------------------------. - - - :: - - --------------------- -- -- II ❑ Distance to nearest lot line ----------------- ------------------------------------------------------------- - Remodeling and/or repairing (describe}_--------------------------______._.___-__._______ --------------------------------------------- -------------------•- ------------ ---------------------- ----------------- ------------------- -------------------- ------ --------------------------------------------------------------------------------------- __..-_ E ------------------------- -----------------------•-----=-------------------------------------------q------------------------------------------------- 4:------------- - I hereby certify that I have prepared this application and that the work will be done in accordance wt -San Joaquin County ordinances, State laws, nd rules and regulations of the an Joaquin Local Health'District, i (Signed)---------- ,. -e -------- --------------------- --------------- ------- --- -----(Owner and/or Contractor) 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 BY A 0'- ------------------------------------------------------------ --------- DATE------ --- ----------------------------- REVIEWED BY-------------------------------------------------- ------- ----- ----------------- ---------• DATE---- --------- -- -------- -----------------------------------------------BUILDING PERMIT ISSUED--------------------------------------------------------------•-------------------------------------- DAME -------------------------------- Alferations and/or recommendations--------------------------- ----------------------------------------------------------------- ---------------------- ------------------------- ------------------- - ------------------------------------------------------ ------------------------------------------------------------------------------- ------------------------------------- --------------------------------------------------- ---------------------------- --------- ------------------------ --------------------- ------ F€NAL INSP N BY: Date- �J [2 F ------------------------------ - SAN JOAQUIN LOCAs. HEALTH DISTRICT ,E 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street SStockton,California Lodi,California Manteca,California Tracy,California II F.P.0 O. - I! f IS f