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FOR OFFICE USE: / APPLICATION FOR SANITATION PERMIT PermitNo. ..... .......... ----- ------------ - r -------- - (Complete in Duplicate) S� ... __3 ------------------1 Date issued .....___.... -.-_--.-_--------------___.__._.-._._..___--.._._.._. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. : '_ -�- _ ----- JOB ADDRESS AND OCATION----- ; f1 ----------------- ' d ----- --- Owner's Name -•-- ----------- - - Phone Addressr -------•------------------------•---••----------------------- r. - ----------- Contractor's Name----.------- Phone--------••---•-------------- i Installation will serve: Residence @ETApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El s Number of living units: J__ Number of bedrooms 9--.- Number of baths _/___ Lot size �-------------------•••-------•- Water" Supply: Public system ElCommuriity system [r3�rivate [:] Depth To Water Table rft. 0 obe�Herdpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C3 Clay Loam ❑ Clay F] Ad Previous APP --------------------lication Made: {if yes,date ) No (� New Construction: Yes No [3FHA/VA: Yes ®r'No El TYPE 'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y Septic Tank: Distance from nearest we _____ Distance from foundation----��-------Materl__&�_�__f✓��` ...--------• No. of compartments_ Size� % 17 __,r sp---.-----Liquid depth---f� -------------Capacity. ......... j i Disposal Field: Distance from reaves well__'_-.._Distance from founds+ion.- . Distance to nearest lot line......... rl Number of lines_________________ ________ _Length of each line/ ---- .-Width of +rench._�___�__--______-..------- Type of filter material R! Depth of filter material_,��f�________-Total length_�e ---•----------=--------••- Seepa�ge Pit: Distance to nearest well_______`"______-Distance f m f ndation__��_.__.�Dis Ance to nearest lot line.-ter��-- Number of pits________________Lining material. _Size: Diameter_ .-..-___...-_.Depfh --r! .�.'�-e--- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material---.___-_____---_____----_____....- ❑ Size: Diameter--------------------------------------Depth-------------------•--------------------------------Liquid Capacity -gals. -_._Distance from nearest building r Priv Distance from nearest well --------------------- ---------------- ---- _ 9-------••----------•---------- ----------� i] Distance to nearest lot line-------------------- --•-------------------- --------•- ------- ---------- --------------------------------------------------- Remodeling ------••------------------------------------------Remodeling and/or repairing (describe):---- ._ -•-----•-------------------•--•---------------------•-----•-.----- --------*_.11 ---------------------------------------- -----------------••--------•------- -----------------------------•-- -•-----------------------•---•---•--------------------------•---- --•-------•-----------------------•------••------------------------------------------------------------------ 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, and rules and regulations of the San Joaquin Local Health District. (Sign'd)-----_----------------------_74 I& --- --------- ---- --------------------------------- rrd?1or Contractor) kBr-------------------------------------------------------- --------------------- --- (r+le) . = (Plot plan, showing size of lot, location of system in valet' to wells, buildings, etc., can be placed on reverse side). O D , RTM T USE ONLY , APPLICATION ACCEPTED BY----- ._ ----- ----------------- DATE REVIEWEDBY------------------------------- ------- -------------•--------- DATE_--------------------------------------.._..---------- BUILDING PERMIT ISSUED----------------------- / DATE------------------- -- -------------------------•----------- Alterations and/or recommendations:.._ ---- / -- • '-f --------•-•--••------ -------------------------------------- i --•--•--------------------•----...-.-----------•-•-----------•-•------------•-- ---------------------•---------•--------------•---•-----------•---------------- ii ------------------•--------------------- :--------------------------------- ------------------------------------•------------------------------------------------------------- -•-•--------- � " !--- • Date-- .-- /- -- =--- •---------------------------- FINAL INSPECTION B :._/�....._... �.- �£� SAN JOAQUIN LOCAL HEALTH DISTRICT 5 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street �j Stockton,California Lodi,California Manteca,California Tracy,California ES Sl;iREVISEO 8-59 2M 5-62 ATLAS x ij "�