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FOR OFFICE USE: — -- .........._---- ------.----------------------------------- 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 hereindescribe . This application is made in compliance with County Ordinance No. 549. iJ oS /gp,_ pg JOB ADDRESS AND L CATI N_ - CI'ea--- �1/ _-iQ[ -- __�11<•I/ _ __� _ 11? / Owner's Name----- _ -------------- Phone------------------------------------ --------------------------------- Address........ f 1 - .._ _.. � rd/. --- ------------------------ -------------------------------------------------••-----•---------•---------------------- Contractor's Name--- ------ Installa+ion will serve: Residence V partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�___ Number of bedrooms 2_- Number of baths , __- Lot size ___ . _ - ------ - -------------------------- i � AWater Supply: Public system ❑ Community system ❑ Private Depth to Water Tablet ft. I 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 2- New Construction: Yes M-I�o ❑ FHA/VA: Yes R— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Is (No septic tank or cesspool permitted ifpublic sew r is ncavailable within 200 feet.) Septic Tank: Distae from nearest w II�_A stance.from/fo�undafion-_ No. of compartments__.._____.______ ized`�_ �i uid de th _________Ca q P pacityl-Z-4-1--c'19--- Disposal Fiefd: Distance from near t wel istance from fcundafonZ�_�__ _-.Distance to nearest lot line _ __ f�„\ [ Number of lines-. ---------f- Length of each line_ `_. i Width of trench_,_-_.__ (Yi Type of fifer material 4 _G_____Depth of filter material__ __________Total length - - ----------------------- Seepage --------- ---Seepage Pit: Distance to nearest well----------------------Distance from foundation-------.------------Distance to nearest lot line--_______..__.__ ❑ Number of pits.......... ---Lining material------------------.---Size: Diameter-----------------------Depth-----.--------------------------- ,b Cesspool: Distance from nearest well_________________Distance from foundation------------------- material_______-.__.__._________________.___. f ❑ Size: Diameter--------------------------------------Depth---- --- �------------------- -------------------Liquid Capacity..--------------------------gals. Privy: Distance from nearest well _____________ ------------------ ------------Distance from nearest building------------------------------------------ El Distance to nearest lot line-------------- ---------------- Remodeling and/or repairing (describe)_________________ _ -- - ,t1ordance ------------------ ---------------------- ---------------- ----------------------------------------------------------------------------•------------------------------------------------------------------ -----�-r ...... ------ ----------------- ------------------ ------------- ----------•--------------------------------------------------- ----------------------------------------------- I hereby certify that I have prepared this application and that the work will be dwith San Joaquin Coun y ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. {Signed} ------------- -------- - --- - -/ {r--t-l-e-1-------------- (G �- or Contractor) By:----------------------------------------------------------------- - ---------------------------- -------------------------- (Plot --------------------------- (Plo# plan, showing size of lot, location of syste relation to wells, buil�dgs, etc.,ca.n be placed on reverse side):—am OR DEPARTMENT USE ONLY s. APPLICATION ACCEPT✓ Q BY_._____.___ DATE------�_7/PX6 REVIEWED BY --- -------------------- ------------------------ ------ DATE } BUILDING PERMIT ISSUED........................ ----------- --------------------------___---------- ------ DATE Alterations and/or recommen da+ions:--------------------------------------------------------------------------------------------------------------------- - -------------------------•---------------------------- ------- ------------- -------------------------------------------------------------------------•----------------- --------------------------------------------- FINAL INSPECTION BY:..---- .......... ---- Date- ------ ----- --- -- S JOAQUIN LOCAL HEALTH DISTRICi I 1601 E.14aielton Ave. 300 West Oak Street _ 124 Sycamore Street 205 West 9th Street I Stockton,Callfcrnia Lodi,California Manteca,California Tracy,California •F.P.C O. 1