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FOR OFFICE USE: r�. -` APPLICATION FOR SANITATION PERMIT Permit No. ------ •in Duplicate) -------- ------------ {Complete Date Issued �:_a..... _.. - 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 'snstall the work herein described. This application is'made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO TION_ �,�LS. -- `' r. """"" Owner s Name__ ---- •. ----- Phone I ---- Address f I 1 ss-------•------------------ - :._ . - one------------ ----•----------- ---- ----- -o"" � - l Ph Contractor's Name_.__. __ r Installation will serve: Residence LcY ^p�tHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _� Number of bedrooms __. Number o baths Lot size ----- ----------- a X.- WaterL Supply: -Public system El Community-system [_1Privafie Depth fiv Water"Table _`"`eft F •�.JC � Character of soil to a depth of 3 feet• Sand ❑—Geavel ❑ Sandy Laam Clay loam [I Clay ❑ Adobe ❑ Hardpan ❑ _w Previous Application Mader [if yes,date._..------ } No El New,Constructlon:"Yes No E] FHA/VA: Yes ❑ No ❑ ` TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL__S�._. ..Dista �e from f dation----. 0-:_.-.-..Material ...__ 1-" -"- -- - No. of com artments- . .. 'r9 X� ,_ Liquidtdelth___..._4...... ........Capacity,_ [� p o�---- --•--� � j`"�.`-�----.- - -- ` -- --_--Distance to nearest 1ot, i"��--- f Disposl�ld: Distance from nearest we{L..-Sa_..._.._Distance from foundatioAXE?p! ce line___..-_.,S__. Number of lines ----------..5' }-- Length of each line__�C__�-��--`, .Yd Width of.,tree h.__.�_�i---------------------- Type of.filter material_".-__- YS.t.____-Depth of filter material_....�.Sc-_`.'-------Total lengfh-.et --.__"---.._"_"__-"- -------- Seepage Pit: Distance to nearest well___________________ __Distance from foundation____._____....___.Distance to nearest lot line------------------ Q Number of pits--- ------------------Lining material------------.--------- Size: Diameter----•-------------------Depth--------------------------------- Cesspool: � f D'stance from nearest well ----------------Distance from foundation... _.----------- ..Lining material__.- - -.---------------------------- I -. _______ _______ I ❑ % Size: Diameter- -- --------- ----- ---------- ---.Depth----- -- ---------------- ------------------Liquid_ Capacity ............----gals. / _ Privy: Distance from nearest well.................. Distance from nearest bui cl ng...____.--..____..____.______--------_--. Distance to nearest lot line -----_.- ..._-------------------------------------------------------------------------- ------------------------- Cl I ff Remodeling and/or repairing (describe):------ ------------------------- --------------------- ----------------------- --------------- 1 0 ------------------------------------------------ :-------- - ------ ----------------.---------------------------------------------------- .... ---------•--- - -----•- # t ---------- ------- ------------------------------ ------------------ -----1--- -----------+--------- --�- ----------------------' --------------- I thereby°ce4aywa e prepared this application and tha+alie'work wit! be done in ac ordance with San Joaquin County ordinances, States and regulations of the San Joaquin Local Health District. (Signed)- -;------------------- ) ,-- " /or Contractor-- -- ----------------- - ---------- ----- -Title------------ Igy:.--------- to ' ----- - { I (Plot plan, showing size of lot, location of sy_t_ in relation to wells, buildings, etc., can be placed on reverse side). I d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I3Y___... '�--G - DATE__._`s� l - -J�l----------- ------- REVIEWEDBY-------_l--------- -------------------- ------------------- - - ------------- ---- ------------------------ ------------ DATE-------------------------------.-,.._---- --------- BUILDINGPERMIT ISSUED-------- -- -------------- ------- ----------------- ---------------------------- DATE-------------------------------- ----------------------- Alterationsand/or recommendations-- ----------------- --- ---------------__--- --------- ---------------------------------- ------------•---- ---------------•-------•-------------- I: I y --- --------------------------- --------------- --- - ----- ------------------------------ -- - - - --------------- --- ._. . _._. .... ------ ------- --- --------- - ------------------------------------------------------- - ------- FINAL INSPECTION BY:._. . .- _ - , ------ ------------- Date..-'_ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1laselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press E _