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i%im vrri%.i: Liar-: - ------ --- - .._.__..._ APPLICATION FOR SANITATION PERMIT Permit No. . ------- ------ ...-- ..._.. _.. .. ----- (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 application is made i compliance wi Cou y Ordi ante No. 549. q4, � ,-/1 e, ) , JOB ADDRESS AND LOCATION i... !-�du�`.. Q. /Q •,..._.../.. ?/'/.-.._.fli!/ d. ...._. 1/,Gi'- 5-.- '� �`" Owners Name_.....ew,_•.A. ........ Phone.................................... Address---- X "� .f- 21-1.!✓E.' Contractor's Name....-Iez7.. --•- _--------------_ ------- .----- - ---- Phone----.- -----------------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - .. Number of bedrooms .... Number of baths . .__ Lot sizeG�f' �f� ........................... i Water Supply: Public system ❑ Community system El � Private tepth to Water Table��. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam UTIClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date. ._... _... ... ) No El" New Construction: Yes ❑ No R?-"THA/VA: Yes ❑ 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,--- ............Distance from foundation......:_..._...._...Material ................. ---------.____................ J�`�� No. of compartments..._ ........ ----------Size depth..._..... ....... _... .. Capacity..._......._......_.... i r r Disposal Field! Distance from nearest well...l,7�_Distance from foundation.-- ...._....Distance to nearest lot line__ . � �/ll 411 Number of likes........ .. ....... .. . Length of each line__. (9 �' g �_a.....�.._._Width of trench.x. ..+._.... t /_ Type of filter materia/ .. lt' ��.Depth of filter material._- 4/6f -..Total length.__4. -------._...........i....- Seepage Pit,- Distance to nearbsIf well_ OQV......._.Distance from fo ndation...__t�...O..".Distance to nearest lot line...,.17r.- � Number O�Vits../�- .__f Lining mate rial-.�0 . . .... Size: Diameter._J.„ .1........Depth.il► � t,.'.• r Cesspool: Distance rom near st well .... `'...._Dista frp�m. foundation.:::-::--': ". ..Lining material......_..._............._...r:._.�t _. _._l ..._ ..._._.._...._ . `` ❑ Size: Dia eter- - -- . . . --.Dept -------- -- • ----- - ..... ............Liquid Capacity- -------------- ---------gals. Privy: Distance from nearest well.......................................... ... ..Distance from nearest building ..... ..........................._.:1:. K ❑ Distance fo nearest lot line - --- --------------------------- -_•---- :.� Remodeling and/or repairing (describe):_........ YIQ ......... .............. ..... ..................................... t ----------•---- ------ -----------------•------------------------------------ _.. -t - ----------------- ----------- + - • ...........................- ---------------.-----• ------------------------------------- ........ .............................................--- - - -- - - - - ----- -- - - --- - -----•---•-----...�-•--•-------------- ------------------------------•------- -------•----------•------•------ ------------------------------------------------ --------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules an regulations of the San Joaquin Local Health District:• f(Signed) - _.. ...... ontractor)..,, By:----------------- f i -----•----• - `. . -- ----..------.....(Title) '........... - -------------- ;(Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y.......... ... �.� .... ------ ---•--... ----------•--- ...... DATE----- `3�� ..V.1111r,7-- REVIEWEDBY...................---- --------- ------------ ------------------------------------ ................................. ------ DATE.--•- BUILDINGPERMIT ISSU D--...... -- ..................................................._---•-••---••----••. ....-------•-..... DATE----------------- .........--................................ Alterationsand/or recommeridations:........................ .. . .......... ... ...•...................................................... •----•-••------ ... ...._.......-----•-----•-•••••---•-•- --------- -- --- - ------------- - ---j.....�. .................................. ....._ . . ---------- -- --------- -------I--------------- --------- ........ ...... ... . .. .............. ............................... ..... -- _...-- --..... ......__........ •-------------•------...-----•----•--•------------ . ---................... --- ------......--•-- . ............ ••--•-. --.._... ................................. ....-------- -- ----- --•--- ............................................ � . FINAL INSPECTION BY:.....�.. ...... ... .. ....... . .. ..... ...... . Dote.-----. ........ ----• -- ... . .--- .............. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 tycamore Street 205 West 9th Street i Stockton,California Lodi,California j { Manteca,California Tracy, California F.P.C C.