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FOR OFFICE USE: ;.. APPLICATION FOR SANITATION PERMIT Permit No. � ---------------------------------------------------------------------------- ------------- --------------------- ---- --- f. .._- -------------------------------------- -- ------ (Complete in Duplicate) _. _ .._- This Permit Expires 1 Year From Date Issued Date issued ._ -_11"------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance with County Ordinance No. 549. Oip3--mo--37 � �0 Co(P3 0 J4 elgu)A} p'8 f JOB ADDRESS AND L C TION-- '- .gi n G s' � �- "at_ _ Owner's Name -X. - --•-----•-------------------------------------- --- Phone--------------------- - Address--------,/ �-,--.�-- '� _-3 23---------;;- --� ------- ---=•------------------------------------------------------- Contractor's Name-------- -ra---=/&elall----------------------------------------------------------•-------------------- Phone----------------------------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �� 1 • O Number of living units: . Number of bedrooms _ _ Number of baths _-4- Lot size __ f C! !� __'_________________-___ 13% Water Supply:. Public system ❑ Communitysystem ❑ Private Depth to Waterjable ft_ tins Character of soil to a depth of 3 feet:.-Sand E] Gravel El Sandy Loam ❑ Clay Loam Or Clay E] Adobe F1 Hardpan El .. 4 Previous Application Made: (If yes,date......... ......i'.__.) No g!�' New Construction: Yes �No ❑ t `FHA/VA: Yes ❑ No Ee —— 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_rj0,9_ _Distance from foundati,,__A**------- at ,r al __5;-- 4r9_ ' --------------- No. _ ___. r No, of compartments_._______ -----------Size•.? __ _,-�„��Liquid depth_ _ f_......-__...._.Capacity__ __�_�_____ Disposal Field: Distance from neares,t�well�azl__.. Distance from foundat __ _. _______.Distance #o nearest lot line____ Number of lines______.'__---___ Length of each line_ Width of trench. ..... --------------__________ Type of filter material ___T __��_Depth of filter materiaL__t""e_.___ __Total length_-_ 2-7___-__ --------------------- Seepage it: Distance to nearest well... Distance fr fou anon___ _.__.Dist Y a to nearest lot Ile____`""_ Number of pits____ _________________Lining material__. Size: Diameter_��__--- ---- Dept hle" ��_._.��%�� Cesspool: Distance from nearest well-------------_--Distance from foundation---____---_-----._-.Lining material----------------------- � ❑ 4 Size: Diameter---- ------ ---- ----------------Depth_--------------- ----------------------------------Liquid Capacity gals. \) Privy: Disfance from nearest well----- -------------- --------------------------Distance from nearest building --__ _______________________________._. [] Distance to nearest lot line-- --- -------------------------- ----- ----- ------------------------- ----------------------- -- ------------- ----------------------------- f Remodeling and/or repairing (describeJ_____________ ! ------- .C______ -----------------__-- ----------- ------I--------- - ----------------------- ------------------------------------ --- ------------------------------------------------------------ i ,r r ------------------------------------------------------------------------------------------ ---- -- ------------- -- -------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d r s and regulations of he San Joaquin Local Health District. (Signed)------------------ v -_--------------- ----- ------------------------------------------------j0waesiiiai�or Contractor) B ---- ------------------------------A' relation - --------- ------(Title)- - ---------- ------- -- - (Piot plan, showing size of lot, location of systto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------� --------------------------- ------ r -------------- APPLICATION ACCEPTED 13Y_________________ ____ DATE__ REVIEWEDBY------------------------- ------ --- - ----------------- ------------------ DATE------------------------- --------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- - ------ DATE------------------------------------------------------------- Alterations and/or recommendations:------------------ - ----------------------------------------------------_------------------------------------------------------------- ---------- ------------- ----------- -------- ---------------- ------------------------- ---------------------------------- ------------------------------------------------------------------------------------- --------- ---------------------------------------------------------- - ------------------------------------------------------------------------------------------------------ ------------------- FINAL INSPECTION Date.,r5" . --------------------------- • SAN JOAQUIN LOCAL HEALTH IDISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5 Stockton,California Lodi,California Manteca,California Tracy,California