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s7 ! FOR OFFICE USE; '+ ------------------------------------------._ ----- APPLICATION FCR_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 in compliance with County Ordinance No, 549. _ JOB ADDRESS AND LOC TION ! -w-j---------------------------------------------------------------------------------------- ----------- Owner's Name__-- -- - ------•-----•-•------------- --- ----- - Phone__?�.�__,1�2�•-• - Address-----------------•- t Contractor's Name-------- ---- ------------------��'s-------------------------------- - - ---------------------------------------------------�...--- Phone---d--�--`�')�'-2-7.�__ Installation will serve: Residence [g--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I.--- Number of bedrooms _ Number of baths:-//� Lot size __ _1-.o.p___________________-.-__-__-_--_.____ Water Supply: Public systt m ❑ Community system ❑ Private ®Depth to Water Table 4P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay ❑ Adobe E?-14arclpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes ®-bio ❑ FHA/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_.574.*-__.__Distance from foundation__-/0:4 ______--Material_ - - -• ----Liquid de th---� .. - ------------ No. of compartments_..__ -----------Size-0,y-°t-§x j" q p CapacitY___/.z Q_o17 Disposal Field: Distance from nearest well%5?0 4.__.._Distance from foundation/_0__4_.__-_____.Distance to nearest lot line--5-`____... ®� Number of lines----I- Length of each line-7S"-'---_--------------Width of trench.R��!-,f... ..___.__- r Type of filter material_' ----------Depth of filter material__1X 4_____'.-__..Total length_--/s 'll`___.__._______________- 0 Seepage Pit: Distance to nearest ----------Distance from foundation__f4__'e--------.Distance to nearest lot line___.__--___.- la-_ Number of pits--�__ ___________Lining material'77�1�-/('-__._--Size: Diamefer._.33_---_-----_Depth__-'Z.--__-_-___-_._ Cesspool: Distance from nearest well-----------------Distance from foundation-_--_.-_--_-__.__..Lining material.-____-..-._..__---_--___---------- . ❑ Size: Diameter---------------------- ----- - ----- Depth------------------------------------ ----------- Liquid Capacity----------------- ---------gals. Privy: Distance from nearest well---_---------------------------------------------Distance fromtnearest building-.--________--__._.____-__-.-_.__.____._. ❑ Distance to nearest lot line------------------ --- ------------------- --------------------------- --------------•------ I----------------------------------------------- Remodeling and/or re airin (describe):____-- dc��c=� ��--_-�--.--_C r------------- ----------- -------- ------ --------------------------------------------------------------------------------- -------------------------------------------••-------------------------------------------------------------------------------- --- -------------------------------- ---------------------------------------------------------------------------------------------------------------------------- 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, d rules and eg ations f the San Joaquin Local Health District. _.._..-__(Owner and/or Contractor (Signed)---------- - - Tliy: _ _:_—:_ = ... ------------------------------ ------- -------------------------- {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------ -------------------- - - 4�----- ----------------------------------------------- DATE------ I AW REVIEWEDBY------- ------------------------------------ ---- ------- --------------------- ------------------------------------------- DATE__._. BUILDING PERMIT ISSUED------------------------------------- D E.-- - _: ------------------------------------------------------- --Alterations and/or recommendations-------------- -��....--- ,� �'f --- -------- --------------------------------------------------------- - ---------------I------------------------------------------ -------- - --- ------------------------- ------ _--------------- ------------------ ------- - ----------------------- -` `= �'l - `4 - --- - - ------------------ _ ----- --- -------- --------------------------------------------------•--- ------ --------------------------------------------- FINAL INSPECTION BY:----------..... :-�--- - - --- - -- - - -- Date--------------- 1 Z.� -.�___- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California w - F,P.0 O. z