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r-UKUN-ILL USE: ------------ ------------------- ----------- ---- --- ---- _ } _..-_ _____. APPLICATION FOR SANITATION P j LXnit No. _24: �_ I t (Complete in Duplicate) 111 "j This Permit Ex Expires 1 YFDate Issued Date Issued - �- Year---- y, L?�o —!so -- 2Z 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 complja a with County Ordinance No. 549- IV , f�1 Pv�! JOS ADDRESS AND OCATI c ___ 1-Pa.naa------1'�_�7__/.__ --___ F rtnn Owner's Name----------- R_ (,�. jM {� �� ------------------------- Phone' Address------------------ i - r��r I Ap Contractor's Name----------C-q ,--------------------------- _� ---------------•------------------ ---- -----. Phone ----------------- Installation will serve: Residence [� A,..partment House Commercial ❑ Motel Number of livingunits: -_r___._ Number of bedrooms 1 ❑ Trailer Court ❑ Other ❑ r _ __ _... _ -- Number,of baths -_1---- Lot size __._ C#� ----------------------- Water Supply: Public system ❑ Community system f � yy ❑ Private �Depth,to,Water Table �,�ft. Character of soil to a depth of 3 feet: Sand (�Gravvel ❑ Sand�,am0�1,;,+YlLoam y ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date_____ _______:..) No ❑ a❑'�FHA/VA: Yes ❑ No [ t �' Ne Construction; Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: 00 (No_septic tank or•cesspool.permitted,if public sewer is available within 204 feet.) ... . _ } Septic Tank: Distance from nearest well________________Distance from foundation____.___, - r f Y T! G No. of compart nenl s S Ze � ------ ------ Liquid depth _Capacity ' Disposal Field: Distance from nearest well____. -_'Distance from foundation 1 e t k it ��' __.__Distance to nearest lot line_-________.._.___ T e of filter material_e - b ----- De th of line _ - �� �� gam_-__-- -- _.Width of trench------2- � a� #: u P ! tee, ,� s. - �-- --------------- a ------------- Number of lines__._-� ______ ___ __ _ _ YP - -.- Length of eachmateriaL .�_g - g s T --" _-Tota# length -------------- 1 13istance from ; k• - Seepage Pit: Distance to nearest well--.-__----_._ foundation----------- _ Drstance to nearest lot line_________________ rw r :- --- P p 1 -� � Liningrterial__1-' Sizj: i7.iameter- Depth ------ 1 Cesspool. D stabce f omsnearest well______________ Distance from<foug�dation ' u_ ---_ Lining m aferial------- ---- ----------------------- 171s Size: Diameter lJl -------- Depth----I------- `r H....Liquid Capacity • ____ . . .._D stance from,nearesf building------------------------------ -_-9a-f S I � Privy: Distance from nearest well__________________..______- - -_ - ❑ Distance to nearest lot line_..____- - ------ -------- ---�- �- --- _4 � Remodeling and/or repairing (descriue)':_______________ ______ ------------------ --------- ----�----------------- ------------------------- Il ------------- i ---------------- --=----------------------------------- } __ .._ --------'------------- -------=------- ------------- ---------------- -- - ----- _- --- - - ------'-------- - ------------------ ------- hereb certify that I have "` -- - -- - - - - - ,�-.�"�• e�-��----�- - �---" -�-- - Y y prepared this application and that the work will'be:done rn accordance with San Joaquin County ordinances, State laws, and rules andiregulations of the San Joaquin Local Health District. ¢t (Si ned f 9 )•--- -- -� - ------- ----------------- ---- -------- --------------- ----------------- ------------.(Owner and/or Contractor) r By __ - - _t ..__-„mom--:._----�--_:�----�>_---�-:-. --_-.,,.,..._:: �{Titiel _ _ r {Plot plan, showing size -f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------- ------- -------------- DATE----- ------------------------------------ REVIEWED BY---- I---- ---- --- DATE BUILDING PERMIT ISSUED: - -------- DATE -------------------------------------------------- --------------- Alterations and%or recommendations: """""”"----- --- --- --------- -- --------------••-------_------- ----------------------------- ------------------ ---- - Ct- .� �f i------ akliAl --- ------------------------- ------ ------------•----•--- ----. . ----------- ------ -- -- ---- - ---- i FINAL INSPEC Z ..l Date-------. ---- i 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 F.P,c o.