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FOR OFFICE USE: ------ ------ -- ------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------.--.---- ---- (Comple+e in Replicate) 4 Date Issued -__ -- '-7/ •� ______________________________________}•___._..__._._ This Permit Expires 1 Year From Date Issued 9 Application is hereby made to the San Joaquin Local Health District for a permit to ton tr�r�/� stall the work hereiK described. This application.is made:in compliance with County Ordinance No. 549.- %3 3' --- � �o'� JOB ADDRESS AND LOCATION < ----�7,L. --__•__--_-__---_-- , Owner's Neme �nR ' -----._ ] Aore ...- r r ��l 6J` Address = ----------=------V� ----------- ------------------------------------------------- --- ---- .......... Contractor's Name------- - ---- -------=--- ------------------------------------------------- Phone..--------- ............... `Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units, .-_�_-. Number of bedrooms _ Number of baths_.___-_ Lot size --.6�G -----_�____________________________-__ � ,,QQyy Water Supply: Public system 0 Community'system ❑ Private �ep+h to Water Table -r:: ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®-'H_ardpan ❑ Previous Application Made: '(If yes,date.......... ........1 No New Construction: Yes'Yv No ❑ FHA/VA: Yes ❑ No 12 . TYPE.OF INSTALLATION AND SPECIFICATIONS: 1 .� (No septic tank or cesspool permitted if public sewer is available within 20.0 feet. Septic T kC: Distance from nearest wel --Distance from foundation__ld_------------ Material_ - ___ _ ----------------- 10 __ _ No. of compartments ___Size___rj_x�._K_ -_-__-_Capacity-- Disposal a acit a v P 9........ _ Liquid depth P Y - Disposal Field: Distance from nearest well .........Distance, fromiounndydation.1b__.�.---------Distance to nearest lot liner'l___-__ Number of lines----- - r( _ ----------------Width of trench---�-(,--------------------- En ®� � ____ `Length.of each li _-__. _a —�?� -------------------- Type Type of filter material_ Q.G<C-------Depth.of filter rriateriall�_/...........Total length----A�fv-___________________________ ;.O' Seepage Pit: Distance to nearest well---------t------------Distance from foundation....................Distance to nearest lot line__._______.._-_.. G ElNumber of pits----------------------Uning material----------.--------'--Size: Diameter------------------ ----Depth-----------------:--------------- ll0 INto Cesspool: Distance,from nearest well__-. _____-_-:_Distance from foundation--------------------Lining material_______--___--_-_--_-._________.___ ❑ Size: Diameter--------------------------t------ Depth---- ----- -- ----------- -- -- -- ---Lquid Capacity- --------------------gals. � T Privy: Distance from nearest well _ _ Distance from nearest building------------------------------------------�- ❑ Distance to nearest loft line- A--------------------------------------------=----------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): ` � = -------------- f� =--------------- -----------•---------••---•--•-----------------------------•---------•--------- ------- ---------••---• - --------------------------- ---•------------------------------------ -----------------•---------------------------------------- i 1 hereby certify that I have prepared thi plic ion and that the work will be done in accordance.with San Joaquin County ordinances, State laws, and rules and regul ns the San oaquin Local Health District. (Signed) `- --------- -----(Owner and/or Contractorl By: , > (Title)Y ---- ------- ------------------------------ - )------ - -r-------------------------------------------------- - (Piot plan, showingrsize�of-lot,-location' o Oerri-in-re +ionao w.ells,_buildings,_etc:-can,.be�placed onmreverse side). F R DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--- - ---- �� -1 _I_ DATE - a'I_ -Cv REVIEWEDBY }------------------------------------------------------------------------ --------------•-- ------------------- DATE BUILDINGPERMIT ISSUED- 3------=--------------------------------------------------- — ------------------------------- DATE------------------------------=----------------------------- Alterations and/or recommendations------------------------- -----------------------•------------------------------------------------•----•-----....-------•-------------------•------------------- s ------------------------------ -------------------------------------- - ------ - •--------------------------------------------------------------------------------------------------- ---------------------------------- - -�-- - -- -------------- - --------------------------------------------------- ----------- FINAL INSPECTION BY:-------------- I__---- Date---------------7 .` ---- ..J� - - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Matelton Ave. k 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 3M 3•'63 F.F.CQ. a