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FOR OFFICE USE: _ l --------- --------- -- Permit No. . lF � -"---�-- ---- �� --------- APPLICATION FOR SANITATION PERMIT f - ----_ (complete in Duplicate) Date Issued Al ' -- -7.-�-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 apprlicatior`is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------------- --------------•----------------------- 4- ' Phone------------------------------------ OwnersName-------L i__4-- --- ------------------------------ --------------- - --- Address_..•---------------�3-1---7----- =._ .--------- --•-••---------------•----.------•------ Contractor's Name-------- - Phone----_---------•- ---------------- - �p -- e ❑ f baths __._/_ Lot rte :_! __te� ` Other ❑] mber of bedrooms _2 Number o -----•----------"---- w Installation will serve: Residence A artment Nouse Commercial Trailer Court Motel t E Number of living units. I Water Supply: Public system Community system El Private E] Depth #o Water Table K5�.4 Character of soil to a depth of 3 feet: - Sand ❑ Gravel ❑ San Loam ElClay Loam El Clay ❑ Adobe �ardpan ❑ pP f Previous Application Made: (If yes,date--------------------) No New Construction: Yesto'No ElFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptic ank: Distance from nearest well-----------------Distance from foundation-------------------Material---------------------------------------------------------- No. -.____.---__----______. -_______-__..___---___.No. of compartments --------Size----------------- -----•--------Liquid dept�-------------------------Ca acit 1 Dispos Li field: Distance from nearest well. G7_:-._.Distance from foundation..-___ �__--__.Distance to nearest lot lined__ ____.. Number of lines________________ __ Length of each line----------- Width of trench_______- -cl------------------ {� .1 Type of filter materiah] A- -Depth of filter material_--___/�_------Total length____.-___ - Distance to neares# lot line__.._-..._ Seepage t: Distance to nearest well__ .__ �' ---___Distance om undation___,� A/ -52 Number of its._______ Linin rrlaterial__ �____-Size: Diameter.__S3--------------Depth____.._ ------"-------- p /---------- g [T� Cesspool: Distance from nearest well-----____-_____-Distance from foundation--------------------Lining material____._ 3 ❑ Size: Diameter----------------------------------- Depth--------- ------- ------------------------- --------Liquid Capacity------------------ gals. Privy: Distance from-nearest well------------------------------------------------Distance from nearest building-------------------------------Y---------- ❑ Distance to nearest lot line------------ ------- " Remodelinp and/or re }erin (describe__ y 4 --- ---- g ------------------- ----------------------------------------------- --------------- ------ i ----------------------------------- --------• --- - F l herebycertif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local- Health District. ----------------------________(Owner and/or Contractor) (Signed).. . R I ----- -------- BY= -. e - - -------- - ------------------ ------------------------ ----- -- -- (Plot plan, showing size of lot, location of system in re'ation to wells, buildings; etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r --- - - ---- DATE....... yc�� APPLICATION ACCEPTED BY-------•--------- -`=- --�c^`�Q� ----------------------------• •- - - �- - --- ----'?p- ------------------------ REVIEWED BY------------------------- --------------------------- --------------- T------------- ---------------- -- ------ DATE---------- --------------- BUILDING PERMIT ISSUED ----- DATE------------------------------------------------------------ Alterations and/or'recommendations:------------------- -- ---------------------------------------------•----------•----- -- C �,� FINALINSPECTION BY:_...�.`-- --:��-'-�-�------------------------- ------------ Date--- ------------- --��-�--- ---- ----------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellan 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 3-163 F.P.CQ. J