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OR.OFFICE USE: I� ----------------- --------------------------------------- 11 APPLICATION FOR'SANITATION PERMIT Permit No. Z.7 �! (CJ_ in Duplicate) - --------- ---- ------ _ . _ Date Issued ....... �� TThis Permit Expires 1 Year From Date Issued ' -/}f -- --------------- Application is hereby made��o 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. 2c50 p JOB ADDRESS AND LOCATION- - ----'` -- -- -_ -------- �0 ` ---------------- ------- Owner's Name------ ---------e ��-- -- --------- ------ Phone----------------=------- • __ �� --------------------- --- ---- -- - ------------------- ---------------�.. Y>�. .....----_--------------- 21- ---_-------------- ~ _4--------------------------- -•----•-------- Phone-----_----------------.......... Contractor's Name___ I _ Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ____ Number of bedrooms . -- Number of baths I___ Lot size -- _________________________ Water' Supply: Public s1s . ❑ Community system ❑ Private Q Depth to Water Table _ ft.- Character of soil to a depth iof 3 feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay❑ Adobe ❑ Hardpan/(JI Previous Application Mader (If yes,date------------------_} No.® New Construction: Yeso No E] PHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , I Septic Tank: Distance � from nearest well-_ 0___.---Distance from foundation__.lbri ____ __________ _ _ __________.Mateal__ _______ ® -No. of eompartme its_.._�'________________Size_3_�_4 ___�_.---_-__Liquid depth____.__''y----._____-._Capacity----I�.._______ N Disposal Field: ` Distanc lfrom nearest weii_476_........Distance from foundation---/P-----------Distance to nearest lot line__) ......... u e nn Type ber of lines-__ ____� --------- of trench___a' _______ ___ ___________ of filter maferial �fyDepth of filter material--/-.?--'*___________Total length__;._!_tom_'_______________________ Seepage Pit: r Distancejto nearest well_,lr_ __ ......Distance from f undation---�G-----------Distance to nearest lot li�e. - [3] Number of pits___-___.___._____Lining material-__ __--Size: Diameter.___. _ - '___--___Depth____.;`xr-------------------- S � Cesspool: Distanceif3-om nearest well_________________Distance from foundation-------------------- Lining material-----_______-------.-____.______._.-. ❑ Size: Diameter--------------------------------------Depth---------------- ----------------------------------* Liquid Capacity----------------------------gals. p Privy: Distance from nearest well'_____.________________________________"_-.._Distance,from.nearest building--_---------------------------- ❑ Distance to nearest lot line__________________ "" Remodeling and/or repairin� (describe)__________ _________ -- _ iI � ------------------- ---------------- ----------=------------ --------------•------------------•-------------------------------------o----_-------------------------------------------------- ------------------- ----- - I!------- ----- �.. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e lawse-and rules regulations of the•San Joaquin Local Health Diitrict. 5 I s (Signed - --- + �"---- !:.- -------------------------------------------------------------------------------(Owner'"and/or Contractor Y:------------------------------ -------•--•--- -- =-----------------=------------------------------------------------------- --' :_(Title) -------- ---- ---- -----T,- .._. .:.--- - � (Plot plan, showing size of 104, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�kIBY- I ? --------------------------------------------------------- DATE-----�-' f REVIEWED BY------ ----------------IDATE BUILDING PERMIT ISSUED1!-----------------------------------------------------------------------------------------------------. DATE--------------------------------- -------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------. ------------ ----------------------------------------------- •--------- --------------------------------------------- II_I------------------------------------------------------------------------•-•--•-- - ----------------------------------------------------------------••--•-------------------- ill; ----------------------------------------- -----• --------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- --------------------------------------------------- ----------- ------ -------------------------------------------------------------------- -------- FINAL INSPECTION BYa - ----- ----- -- -- ------ - --------------------------- Date.---l�--- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California . I ES 9 REVISED B-59 3M 3-'63 i.R.DD.