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3 � r�3K UFFICE USE: --r------ ----- - ----------------------------------------------------_-- APPLICATION FOR SANITATION PERMIT Permit"No. ._ --------------- ----------------------- -------------- (Complete in Duplicate) '[ --------------- ----- ------------------------ This Permit Expires 1 Year From Date Issued Date issued /7- -. 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. tc, -A Ufa JOB ADDRESS AN LOCATION------_-4_ -'f---�--C L r- d e y� � s ------------------------------------------------------------------•------------ Owner's Name--------L_d--------- Address ------ f .. __k ----------------------------------------- - ----- -_ ==---'--------------- - Phone-----•-------------------- - Address - --.-Q/-------a 4r!6 � L/- +----- ' 4' / Contractor's Name------- -------- r !s_ r------------------------------ --- ------ Phone Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: J___- Number of bedrooms -4---- Number of baths _?-___ Loi size -------e.!,-X ------------------------ Water '____________________Water Supply: Public system R- Community system ❑ Private ❑ Depth to Water Table 6 T 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 [�J- No ❑ FHA/VA: Yes [T` No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL_W-i�-_c__Distance from foundation___1 0___-_- Material--f�jr cc _ c [g- No...of.compartmentsi__-- -----° Size_ Y_zC_ X-- --`.-_-Liquid depth -------------Capacity--1__ c_ Disposal Field: Distance from nearest well.-/!/4K�Distance from foundation----?.Q---.---_Distance to nearest lot Q` plumber of fines------- ----Length of each line__ _°_'____ ,--P------- Width of Type of filter materiaL_ u -- ---Depth of filter material---10"_---...__Total length----r ��4-_r-_- -_` Seepage Pit: Distance to nearest well_ ---.-Distance from foundation---1 v-----------Distance to nearest lot ---. line__._5___ .t Number of pits-----Z- ----- --Lining material__ _--_ - ----- .3_. -l ----.. ept ------ -5_ ---------------- Cesspool: Distance from nearest well-- Distance from foundation------------.-------Lining material-_--.______-_.___--____________- - ❑ Size: Diameter_______________ _ ------- ------- -----Depth----------------------------------- Privy: - --- -------- -------------- -------------Liquid Capacity------ ------------- -- gals. Privy: Dis a m nearest well------------------ ----------------__------_-__ from nearest buildin g----------------------------------------- Distance Distance to nearest o in ------------ Remodeling and/or repairing (describe)_------____________._._ ------------- --------------------------------------------------------------------•------------------------------------------------------------------------------•------------ -------------------- k ----------- ----- ----- ------ - - - ----- 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. (Signed)---------- �....... ----- .......... --------------------(Owner and/or Contractor) By:------ -----•------•—Q--------------------------------------- -------------------------------------------------- -----(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----------- lvl l V` _"- DATE-----= yam _ REVIEWED BY ------------ . ----------------- ---------- DATE---- -- ILDINGPERMIT ISSUED----- -------------- ---------------- -------------------------- DATE--- ------------------------ ------------- -----------j-- Alterations and/or recommendations:----r--=?f IT4---(__j~ .c` ----- ` = ` e='t_` � _L------- ` ______________________________________________________________________________________________________________..____.__.___._ ________________ _____________________________ FINAL INSPECTION BY:----- r-i = Date =/ _ SAN'JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Hazelton Ave, 300 West Oak Street .124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California C,F.0 O.