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rUx ( -l-I-t ubt: --------------------------------------------------------- ------------- ----------------------------------------------- -------- APPLICATION FOR ,SANITATION PERMIT Permit No. Zeez��.. ------------- ---------------------------------- (Complete in Duplicate) --------- This Permit Expires 1 Year From Date Issued Date Issued -�.r --- "-�� 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. JOB ADDRESS AND TION- - 4/1- Cs14 5 _ -SQA! (e D.t1ltFfr/--)I116� '• j ,-... Owner's Name ------ ---------------------------- Phone....... . Address--------------------- _ _&? ``�r/ � '" - '�..`= - -'-`... // Contractor's Name ---------------------------- �2 Phon,4 7--- Installation will serve: Residence ❑ Apartment House ❑ Commercial V1 Trailer Court ❑ -!)-Motel ❑/ ElOther --7-- Number of living units: ------_ Number of bedrooms -------- Number of baths -__---- Lot size ---�-�__3_ --_�41-1----JE77 ..•- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -. Q 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 56 New Construction: Yes No ❑ FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ;R Septic Tank: Distance from nearest w I--DQt�----Dista c- from foundation--j -___-._.Materi FI!-- -- ------ --- - No, of compartments---p1----------------Size-(------ ---------:---Liquid depth_-- 4-------------Capacity..)-i-?, -- Disposal Field: Distance from nearest well.g_9_5__--Distance from foundation-_A9------.._.Distance to nearesf lot line--- -------- 1I d Number of lines--l�" __-[t-. ..__...--Length of each line----7�-_--o.----_)Width of trench-__- .. ------------------- �. Type of filter maferial-A-p-r,-n•x�_Depth of filter material-----j$srei--..Total length_-_.-ri0�- -------_-_ Seepage f$: Distance to nearest well-_21S from foundation_147-__.......Distance t nearest Ibt line--.�- -- �1 y � Number of pitstl"Wfi.)---Lining material./.�C` ---...Size: Diameter _rX- Deptn_....lQ--------------------- --- 10 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Pning material".--__----------------------------- O ❑ Size: Diameter----- -------------------------------De th-.------------------------------------ -----------.-:Li Capacity -- uid Ca Depth I q p - Y--------------------- •--gals. Privy: Distance from nearest well-----------------------------------------------_-Distance from nearest.building-,_ t ----- ❑ Distance to nearest loft line- --------------------------- _____ Remodeling and/or repairing (describe):--- --------------------- ----- ,�--------- _ ----- c -------- ----- ----- -------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- -- ------------------------ I here6y certify that ! prepared this application and that he work will be done in accordance with San Joaquin County ordinances, State laws, n rul and regulat' ns of the San Joa to Local Health District. � r (Signed)--------------------------------- ---------- (Owner and/or Contract - A - j - -- .{Own d/o or( By---------------- �'-' -- K:i f -- ---- Title -- - ----------- -- •--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can(be pla on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- o DATE 1a�� REVIEWEDBY ----------- ------------------------------------------------------------------------------ DATE ' BUILDING PERMIT ISSUED------------------------- -- ------- - -- - ------ ----------------------------------------- DATE ------------- Alterations and/or recommendations:--------------- - a - ------- ----- ----- ---- _---------------------- ----- � ------------------------------ - --------- ------ ----------------- _ ---------------------------------- ---------------------- - ------------ ------ --- ------ ---------------- - ------ ----------------- ----------------------------------- ------------------- - --------------------------_------------------------ + + FINAL INSPECTION BY: - ---.-- --------------------------- Date......Ca'1316tS----- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.QP.