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FOR OFFICE USE: ------------ ---- ----- Permit No. . """ -�------� �-"------ APPLICATION FOR SANITATION PERMIT ��--�=��--• ' (Complete in Duplicate) Date Issued . ---------- �- -+®� This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permitto rc`oonstruct and install the work herein described. This application.is made.in com liance with County Ordinance No. 549. flay-lS�- u rf6G _ -----.---ems JOB ADDRESS AND LOCATIO �a •hex ° -`- - -� ------ ----------- ---- Phone------------------------------------ Owner's Name--- ---- ------------- --•----•---- ------------------------- - J Address .��4Ft a - a�,-------- --may-- -'r ' -- Contractor's Name-------- ' / --- ------ -- --l- --� -----• .---------- + -------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ff Fx_ "'' mh .r �'b th Lot size o-r �'------•----------------•----- ' m E l,odrs;OL�1f .r___. Vum er of ljaiAs __(---- Lot size Water Supply: Public system Communifi system ------------------------------•---------------- ppy' Y ❑ Y y ❑ Private Depth to Water Table Charar_+ar r,; a ;l s.. . 1.._it r, e ® p � ft. Character of soil to a depth of 3 feet: - Send.tT Gravel Ll 5anay Loam 1J �.Iay 4wa , IJ; �'�r ---- Previous Application Made: {If yes,date.'_ ___..'_. -) No ❑ New Consfructibn Ye"s ❑-"N'o ❑-..._"FHA/VA: Yes ❑ No ❑ PP - - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septs ank: Distance from nearest well___-------Distance from foundation----------------.Material-__.._ °'-'-� `---------- --- '�rr Q f r ---------Capacity__ Baer I -------- -.Size_ ----- ------�--- -�--`-S-�-___Liquid depth----------- - - I No. of compartments__.__ . _-_-- - Oji I ( - Cyb Dispo Field: Distance from nearest well__:_ d----";Distance from foundation__-10--___.-----Distance to nearest lot line____._______. Number of lines------------I----------------------'Length of each line-----1,D6 `----;--------..Width of trench--- -;----,-------------------•- Type of filter material___._��'-------Depth of filter matenaL___..��___�__.____:_Total length___.►Ofz__ `-------- tt Seepa Pit: Distance to nearest well_-----I_P�__----::Distance from foundation----.f_P_----__--.Distance to nearest lot line-- ----------- Number of pits--------2'--.-----Lining material------SsrL!--------Size: Diameter._.----3.3 ------Depth---Z`�-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------."------- ----------- Size: Diameter..--- - -- ---------Depth----------------------------- Liquid Capacity gals. Privy: Distance from nearest well.______-- _____-t _Distance from nearest building.---------------------------------_-_.-_ , s ------------------------------------- El - ------- ------------- --------- ❑ ----------- Distance to nearest lot ine.__--------------------- - ----------------'-------------------- Remodeling --" Remodeling and/or repairing (describe):________________ -----•-----------------------------------•------------------- = ----------------- --• ------------------------------------------------- t -------------------------------- --------------------------------- - -------- 4 f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun y ordinances. State laws, and rules and regulations of the San Joaquin Local Health District: T = --------- - r;and/or ontractor 5ined ------------ ------------------------ ---------- -, C (Signed) X /j ' ' '' x. L'�uz `` -------------- By: `- I (Plot plan, showing size of lot, location of syn+em in relation to we1(1�1s, buildings, etc., can be placed on reverse..side). FOR DEPARTMENT USE ONLY I DATE-- G^ -.i'�- ----(�--------------------------- APPLICATION ACCEPTED BY__ REVIEWEDBY----------------------------------------- ------------------------------------- ---------------------- DATE ---------------- --- --------- - ---------------•------- BUILDING PERMIT ISSUED----------- .--------"----------- - -------- -------------------------- - Alterations and/or recommendations:- ------------------------------ ----•-------------------------"----"-----------" I ------------------- --------------------------------------------------------------------- - -------------------- FINA-L INSPECTION BY:.. ?'� ' ------ ---------------- Date._ ._- _ ---------------------------------"----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1 F.P.CC.