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FOROFFICE USE: - ----------- -----------------'--------------------------- --------------------------------------__.--._._.______- APPLICATION FOR SANITATION PERMIT Permit No. ._1..(�_ _ --- ---- ----------------- ----------------------------- (Complete in Duplicate] -------------- 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. 2,_-9�.��c&e SD JOB ADDRESS AND LOCATION__-_____ ._ Owner's Name__. X ------------------------ ---------------- Phone - - --------- Address--.............�.: ' *�� t<.� -------- --------•------------------------------------------- --•----------------------------------------•- Contractor's Name----��-------'moi,- 4 .U_..__. -------------------------------------------- -----------------------------------11--------- Phone----------------------------------- Installation . -------Installation will serve: --Residence Apartment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other ❑ Number of living units: __ _____ Number of bedrooms _.?f_- Number of baths J_--- Lot size _6_07t7 i Water Supply: Public:system ❑ Community system ❑ Private OQ Depth to Water Table `x.Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam X Clay [❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date___ ________________] No E] New Construction: Yes E] No E] FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r 1 ' Septic Tank: Distance from nearest ____. ._.__Distance from foundation__ _ _____ --------- --- ------- i ❑ No. of compartments --------------------------Size---------------------------- ---Liquid depth--------------------------Capacity-------------------- Disposal Field: Distance from nearest well______ _______ __Distance from fodndafion--------------------Distance to nearest lot line------------ ❑ Number of iines-----------------------------------Length of,each line----------------`-:-------_--.Width of trench-----•-----------------'--:-_----- Type of filter material___-__--__._._ - i Depth of filter material-----------------------Total length---I--------------------------------------- Seepage Pit: Distance to nearest well---- _._----.'.Distance from foundation'��r�_________.Distance to nearest lot line_.--_______ Number of pits------ --------------Lining material_/4n�t ---------S e., iameter.-_-�{ % Depth__.. -------------- Cesspool: Distance .from nearest well-._.______________Distance from foundation-------------------Lining material__--.._____.___ 0 ❑ Size: Diameter =----------'Depth------------------------ --r----------- ------ Liquid Capacity- .------------------------gals. 3 - - Privy: ..__. Distance.from nearest-well______________________ _►: ------------_distance from nearest building ------ ----- Distance to nearest lot line--------------- --------------- ..___________ --� --- ----- J=am Remodeling and/or repairing (describe):'___ _._ ir.-- ---- s{ ` _ - - ------------------------------------ - __________----------_-------------------------- ------------ --------------------------------------------------------------------------- ----- -----------------------------------------------------------------------------------------------------------------_----------------------------------------------------------_____________________________________ I hereby certify that I have prepated this application and that the work will be done in accordance with San Joaquin County ordinances, Sta :Iaws,�and7rules:and regulations of the San Joaquin Local Health District. F (Signed)ne *• g ----; _ ------ --------------(Owner and/or Contractor) By:------------------• _ Title ------- (Plot: (Title) (P.lot plan,_showing=size_of_lot,_locat ion ofsystem.:in relationrvto wells;..buildin s etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY____�e10C1_n�� ----------.----------------------------------------------- DATE__ - REVIEWED BY-------- ------------------------ --- } ` - ------------ ------------------------------- ------ ---------------------------------------------------------------------- ------- DATE----- ------ BUILDING PERMIT ISSUED--------- - -------- - ---------�------------ -------------- �--------- DAZE.-------------------- Alterations and/or recommendations:--------------_.f -------------------------------------------- ---------------------------I---------------------------I-------- --------------------------------------------------- --------------------------------------------•-------- ----------------------------------- --------- ---- -------------- w FINAL CT INSPEION BY � �� -_ - Date- --------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nexelfon Ave. 300 West Oak Street 124 Sycamore Street 205 Wes+9Th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'43 F.P.CD• E