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FOR OFFICE USE: ----------------------------- --------'------------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 5.e--��-`S' --------------- ------ -------------------------- - (Complete in Duplicate) "i rn ____________________ 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 herein described. This application is made in compliance with County Ordinance No. 549. 1� JOB ADDRESS AN OCATION_/`__y'—.�-_-�-�.------_ __ •-� --�(----vu�-�P-___4cr_�7r��-�� Owner's Name- --- - ----- Phone------------------------------------ Address ------------------ ------•-------- Address------------- --- ---� -----�°� ------- -------------------------------------------------------------- r ----y , Contractor's Name-------- -- ----- ---- - - -,.—e--------•-- ------------•----------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [—] Motel ❑ Other E]Number of living units: ---/--- Number of bedrooms __`Y/- Number f baths __�.-__ Lot size ___ __________________ ______________.__________..__._ Water Supply: Public system El Community system ❑ Private Depth to Water Table _______ ft. 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 ❑- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .,t (No septic tank or cesspool permitted if public sewer is available withW'200 feet.l Septic Tank: Distance from nearest well-----------------Distance from foundation----______________Material--------------------------..___.____.____-____. No. of cam artments________________-______--Size___-______________..___4----Li 4---Liquid th------__-..________. Capacity❑ p 9 p. P Y Y Dispos Field: Distance from nearest well-SP...'f._Distance-frornJoundaf ion___Io-----------___Distance to nearest lot line_-_-___..... er of lines Typebof filter materia___._F��_�.________DepthLength offf Iter mlaterial al'4 �_' --__.Total Width le length trench 1- -,�----------------------- t•--. .r r� i zee�x:' . Distance to nearest well._ 4R__--._______Distance from foundation __/Q'_._.-__.Distance to nearest lot / I / r ., ❑ Number of pits.-------1------------Lining material------:._P -Size #er-_ ---X___�B_--Depth-.----- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material __.___.....-------------.--.-_.___.-. ❑ Size: Diameter-=---------------- -------Depth----------------------------- ---------------= ._Liquid Capacity gals. Privy: Distance from nearest well---------------------------_---------------------Distance from`nearest building______.._________--._-_______...__..._. K ❑ Disfance to nearest lot line-------- - - -------------------------------- --------------------- ---------------------------------------------------- ---------------- f .. Remodeling and/J.r repairing (describe) - -- ----------^-------------------------------•------------------------------------------------------------------ -------------------- -- =f----------------------------------------------- -- ---- - -Y ------- ----------- -------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ---------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, and rules and regulations of +he San Joaquin Local Health District. (signed - ------------------------------------ nd/or Contractor) ' - ------------------ - - (Title) (Plot plan, showing size of lot, location of system in lotion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------- --- ---7------------------------------------------------ DATE-.3'2— ---Y(---------------- ------------ REVIEWEDBY- ------------------------------ ----------------- -------------------------------- ---------------------------------------- DATE------------------- --------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------•--------------------------------- -------- - ---------------- DATE--------------------------- - -- Alterations and/or recommendations------- --- - ---------------------------------- -----•------- ---------------------•--------------------------------------------------------------------------- ------------------------------------------- --------------- --------- --------------------------------------------------------------------------- ------------------ -----•----------- ------------------ ---------- ------------ ------------------------------------------------------------------------- ------------------------ --------------------------------------------- ------------- FINAL INSPECTION BY: ------ Date -.Y~:2 ,------'------------------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.