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FOR OFFICE USE- ------------- ------------ APPLICATION FOR ----------- ---- -------------------------- SANITATION PERMIT Permit No. .... :�.�5_`.... f ° J (Complete in Duplicate) _ : - . .- , .Date Issued ----r ----------------------------- -- -:-----"---: This Permit Expires 1 Year From 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. T- g JOB ADDRESS AND LOCATION ----- 1 � � C•`-�'`-�• ----------- Owner's Name-------------- ------------ ---------�� -v'!�'.: _ -----wPho ne Address .. .. {cmc- - ------------ Contractor's Name --7--••------ - -------------•--------- ---------------- - ----- ------------------------- Phi - 3 /" Installation will serve: Residence ApartmerirH-'�-❑--Commercial-•❑—Trailer---Court ❑ Motel ❑ Other ❑ Number of living units: "-__C. Number of bedrooms __ "__.Number,of baths __ Lot size ------ Water Supply: Public�system XACommunity system E] Private E] Depth to Water Table _.L_.2--ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,dote--------------------) .No ❑-°" New Construction: YesXii No ❑ FHA/VA: Yes 0 N TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool 'IP ermitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ '�----Distance.from foundation------ 1q-;---.Material--- No. of compartments-........... Liquid depth---- ------""----------_Capacity-----_.� _ �_._____:Size,_._._�`��_� �^ DVI Field: Distance from nearest-well-- --._==Distance_from_foundat.ion.:_:_:�0-".-Distance to nearest lot line---., Number of lines______..____'7"___.-._____- 'Length of each line______________ � __ _._.Width of trenlcli`-"._ . ,`�/ vj Type of filter material"_ , ]�__ epth of filter,material-------------- __"Total length_:__p_s_{ .__ 5 ---------------- Seepage a. ""- -__ s See a e Pit: Distance fo nearest well_______________ _ __ Distance from foundation_________ p g _ _ __ --------Distance to-nearest lot line_.___._._________ Cesspp Number of Its,_---::---------------Linin material---------=-- _.__.Size: Diameter-----------.— -------Depth-.--------------_--------------- ool: Distance from nearest well__------_g_-__Qistance from foundation___.__._____:_____.Linin material al-------------------------- - ------- Size: Diameter-:"""""- -- --------De th--------------------------------------: ---- -----Liquid Capacity als. ' Priv pistance to nearest lot linle_ -------------------------------- " -----------------------Distance from ----------------------------------------- Remodeling --- _____________________________________ �r „ 3 _ v1 y' 9------------------------------ Distance . Remo ,..� ..� �. --------- ----------- l deling and/or repairing (describe=-=---------------f----- I------- ------------- ------------------------------------ ------------•------------------------- ---------------- ----------------------------------------- --- r - --------------------------------------------------'------------------ -------------- ------------------------------------------}: s ---------- d ,a Y , ---------------------------------------------------------- ----------------_-•--•------ -"----------------- -•------ ---------- ------------------------------- --------------- ------- ----------------------- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County. �1 ordinances, State laws,' and rules and regulations of the San Joaquin Local Health District. (Signed) ----------- - m------------------------------------�----(Owner.and/or 'Contractor) r ; By:---------------------7-----------------------------.------------- ------------------------------/---'L-_--- - ----- -----'(Title)-=:=------'------------.--._._...- ---• . . - --------------- (Plot plan, showing size of lot, location of sys+em in relation.fo wells, buildings, etc.,.„can_be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------= ---- -------- DATE f REVIEWEDBY-------------------------------------- ------•---------------------------------------------------------------------- -----DATE__----------------- ------------ BUILDING PERMIT ISSUED--------------------------------------- ------ ------------------- r - /��E Alterations and/or recommendationsi___1"S7-- �' '-' ter ""— �' - - - / .fi . a 1 4" �' ` -- -- ------ ---- ------------------ ---- - --- --- -- -- --------------------------------------------------------------�---- .----- ---- ------------------------------------ ------ ---------------•----- Date/ ----- -`—- - � FINAL INSPECTION BY:- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha3telton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD. �"'