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FOR OFFICE USE: = h - ----------- �_`y________ 4 .y�APPLICATION`,,FOR SANITATION PERMIT Permit Nof.g:: °.4'.. 7i .7 , ` � 7 ., „4 0 i°' - - -- - - ' . (C rFsplete in Duplicate) t� •�..,;# �,. � Date Issued -�--�=-`=------- --------------- -------------_ ---_.___......._......... /This Permit Ex>,irs .1'Year From Date Issued u �. _ Application is hereby made to the San Joaquin Local Health Dis+ssct for a permit to construct and install the work herein desc •bed. This application is made in compliance with County Ordinance No. 54)-. //J A/•+�1 e /J7 JOB ADDRESS AND ACATION-- f fw,/'� 0-_f ---1'V"/�-� j ---- `---- � � Owner's Name ,, /C� ! f'1� _1 --.`�Plione----------------- Address-- ...�Lc.� -----------•-- •-•-- �.. - -•--------- Contractor's Name-- j 1. _ Ci. ...--------------------------------- --:--- -- .. .,r ----------•- _ n ••--- - ---------- -------------- -------- - -------------- --: Phone�'."�-••-----•---- ,rn' ,.n i Installation will serve: Residence ❑ Apartment House ❑""Commercial� ailer Courf';❑ Motel ❑ Other Number of living units: _X__ Number of bedrooms -__ I Number of baths _is�„rLot size -------------=--"-------•--••--•---•------------------------ Water Supply: Public system ❑ Community system ❑ Private Ckirfpth to stet Table' - �ft:i-�--� , i Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay LoamClay E]. ,Adobe lardpan El Previous Application Made: (If yes,date----:.-_'.__..-..-__) No New Construction: Yes l0 0 •, FHA/VA: Yes ❑ No k;--- TYPE OF INSTALLATION AND SPECIFICATIONS: `+J' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 2-0-1 Septic T Distance from nearest well-_Q______..__Distance from foundation__ _____________Mateiial_._.____ :__ _----. No. of compartments_.____ —------------- �' __ ___Li uid de th----- ------------- Disposal Field: Distance from nearest well_ !t _�_Distance from foundati n___/�__.'_ .--Distance to nearest lot line.__-�.._. !' De th of filter material.... _ --- ....Total filen th_-f___.-��_� , t Number of lines-------_�-- t-7� Length of each line------- --��-----_-:_-- g 1 - .Width of trench..'->��.---•--------------- �, Seepage s : Distance to nearest well_._._ _-��.---- T e of filter material___ .�$r�_ - Distance fr m ioundation___ � t Distance to nearest Po line_`-�J.. Number of pits______ _______________Lining material._ i+a' __-_-Size: Diameter_2.�._FJ.___. Depth t Cesspool: Distance from nearest well-----------------Distance from foundation--------------0__.Lining material: .1_3X :.-_------ ❑ p --I 9 Capacity ---- ---------------- --- Size: #_)iometer----------------------------------- -De th___._._______..__-__-- _-.- _ -- _ _-- -- _ t.._Li uid Ca acit gals, r Privy: Distance from nearest wel-----------------------------------__-._-__-_-__Distance from nearest building..§__ - - ' ❑ r Distance to nearest lot line------------------ i ( -- ----------- Remodel -_:__.-- -_ I - - ; 1 Remodeling and/or repairing (describe):--•- --- ------------------- ------------------ --- F------------------ ., -------------�-------------------------.-----•---------------------------------------------------------------- ---------------- -----------------------------------I I - hereby'certify'that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , a rules and lations of the San Joaquin Local Health District. ' (Signed} ------ - --------(Owner and/or Contractor] // BY:-------------------------------------- ---��---------d'[�� .-----�_ - - - -- -- -----(Title)---�f�'-Ls�e�'---..........-----................. �r (Plot plan, showing size of ot, Iota+ion of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- r�------ 2�r 1. ------ DATE----.-- _`------ --` ------------------------------------------------ DATE------------------------------------------------------------ , BUILD NG PERMIT ISSUED--------------------------REIEWED BY '.--- --- - ----------------- ----- . ' Alterations --- � �` pAT and or recom endations:.__.___.___ - � ` - -c. � t � - c f — ---------------- -.____-_....�__. _._•-______-___ _____ _-_________________-..----_..____R_�" ..__..__._. ._ 'r7---- - C-zc� t t .c? +- rti�� ------t----- v = _�r ----------- ca—� ---��-. ��.---- w tom- -------- r FINAL INSPECTION BY:..___.-- Ry =- Date--.--- ----••------- -.. . SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California l F.P.CO. s-_.