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FOR OFFICE LISE: y - Permi+ No. ( 3- APPLICATION FOR SANITATION PERMIT ----------------------------------------------- --------- (Complete in Duplicate) ii 6 - ___ --------------------------------------------------._. This Permit Expires 1 Year From Date Issued Date Issued G --------- 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. JOB ADDRESS AND ATION---------L?�------ t -- -------- -•-•--... Owner's Name--------- •---- -------- --------------------------------- Phone------------------------------------ Address--------------------------------------- �--•-- --------- ----- --------.....---------•-------------.......-•-------------•---•-•---•------------ Contractor's Name--------------------- - ----- _..-------� --- ---- --------------------------------------------•--•------.--. Phone----------------------------------- Installation will serve: Residence Apartment House a Commercial ❑ Trailer Court ❑!-Motel ❑ /Other ❑ Number of living units: ___(____ Number of bedrooms Number of baths _1_.... Lot size .___1_ __ __._p ---------•-------------- Water Supply: Public system EvIcommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ 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_________________Distance from foundation---- 6__..__.Material------C+__C.__1 :T !4_..r___.____. 21, No. of compartments--�----- ---------- Liquid depth___r'�x-----------------Capacity__-- . Disposal Field: Distance from nearest well---___-----.-.Distance from foundation_./Q..�________Distance to nearest lot line______._.__. Number of lines___ Length of each line_____________________________Width of trench_._,;.) ------------------ Type of filter materiaL7 e_5-_�______-_Depth of filter material.__�_e._1-_____Total length----------- ----------------------- 9 Seepage,Pit: Distance to nearest well-.____—-------------Distance from foundation__/....___------.Distance to nearest lot line_ _____--. (�� ll Number of pits--------,J-----:.____--Lining material------YAG-- -Size: Diameter.-.-a3_�`..___Depth___--5--,-•------------- "�l Cesspool: Distance from nearest welL________________Distance from foundation-------------------.Lining material------._--_-__•__-_.-________________ ❑ Size: Diameter---------------------------------- ---Depth-----------------------•------------------------ Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_:-------------------------------------Distance from nearest building-------.---------------------------------- ❑ Distance to nearest lot line------^-- ----------------------------------------------------•------------------------------- ----------------------------------------------- Remodeling and/or repairing (describe)-------------1-1t.?,j-_J--------- 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 and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- ----------- ---- --- (Owner and/or Contracto r ( -'<--------------------- -----•--- By:------------------ --------------` ------ --------------- -- -------------. (Plot plan, showing size . of lot, loco ion of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -- •----------------------- DATE--- REVIEWED ATE--REVIEWED BY------------------ ----- -' ---------- - -------------------- --------------------------------------------------•------ DATE------------ ----------•-----------•----•---••-------------- BUILDINGPERMIT ISSUED=f ------------------------- --------•----------------•--------------------- DATE-------------------------------------- ----------- Alterations and/or recommendations•_/ r=--:_.. '� z L �7 `' -------4=�h,- f �' ----r------- / G- �` �• --- ------- •----------------------------- w -----•�-__-meq.-�3-----�• ---�i�..'°�-------�-� -�.- --- ��-----�-��'-A.-------F^�•►�•-�P--• ------ -�----- -------- U-1Zt�n-i-14------- '�YL ...... - ------------------------- ---------------- --------------------------------------•------------------------L' - -s---------- - ----- Date----- !,l.__✓� 1.._"-_� ----- - FINAL INSPECTION BY-- - ------ ------ -------- / - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 495 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California [8.9 AEVI6 EP 9.58 r.P.0 P,aM 6-6P