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FOR OFFICE USE: k -------------- --- ----------------- ----------- 4�7 q -_ --------- ------------------- ________ APPLICATION FOR SANITATION PERMIT Permit No. .11.-8 If- '(Complete in Duplicate} t... --.-.- I This Permit,Ex fres 1 Year From Date Issued i 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. 549. # JOB ADDRESS LO iON -_7r_ . '' __.:__.. Owner's Name7 ---------------------------------- ----------------- ------ ---------------------- Phone------------------------------------ or Address - ------------------------•-- •--------------------- ----------------__-------------•--•--------------------------•--•------------------------------------ Contractor's Name_ j`...______ _ - ��_ ------ __________ - - Phone. Installation wil` serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: __ __Lmmunity mber of bedrooms _ ` ._ Number of bat :/____ Lot size ��11*19_- hs. Water Supply m Public syste ,❑ l system [3 Private �epth to'',1+1!bter Table zv. r, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Learn ❑ Clay Loam ❑ Clay.'-E] Adobe ®ardpan ❑ Previous Application Made: (If yes,rdate__-_-------------) No ° New Construction: Yes ❑ No.�FHA/VA: Yes ❑ No g�- TYPE OF INSTALI"ATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within`200 feet.) t Septic Ta :. 'Dista66e'f�6m nearest well_________________Distance from foundation__._i____�-!"":Matena----------------------------------------- No. _ _______._*___________.___._...____.___. No. of compartment-s------------------- ------Size------•-------------- - -------Li Liquid depth!.---'. -- ` _ _ _ Capacity--• ------------------- �y - Disposal Fy�''eld; Distance from nearest well.__? _Distance- from foundation_'A�___+____..Distance to nearest lot'line_4___�__- � �T;' r Number of lines--------- - -- - Length of each line--- -- Width of trench- =------------------•.. f i Type of filter).material_/-_-,.�! Depth of filter matenal___� --------Total length__rZ�__��'____________�______ t *: af ?r m,�I___.S fio Diameter .Distance to nearest lot line_______._ Seepage it: Dis#ante-to nearest well__ ��_g Distance fr m,foundation__ _ _.��____ Number of its----- - - -----------Linin matercal-- - - ---- - -- ,�-------=i----°:--Depth.?�'---------/�xe--- Cesspool: Distance from nearest well-------------_---Distance from foundation---.-------------__ Lining materiaf-------------------------._._______. ❑ Size: Diameter--------------------------- ----- ----Depth--------------------- --------- - ---- ------Liquid Capacity----------------------------gals' Privy: Distance from nearest well----__________________s_.-._______.____._.____._Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line. -------------u-- --------------------•-------------------------------•---------------------------------------- Remodeling and/or repairing (describe): --------•-- ------------- -------------------•------------------------ ••------------------------------------------ ---------------------------------------------------- +'-- ! here . ^_— _= - _----- - r -- ---------------------------------------------------------- by certify-fira�'I'h-ava prepared this application and that the work will be done in accordance with San Joaquin County �, ordinances; State laws, and rules',and regulatio of the San Joegyin Local Health District. (Signed}--------------------------------------------- = -------------------- --- ------ -1 _ /or Contractor) � By=- --------------- (Title). ------------ V Plot plan,Ishowing size of lot, Iota tioA70 system insre! , on!to wells, bdildings, etc., can be placed on reverse side). 1-------�»-..�- ..1 FOR DEPARTMENT CASE ONLY i APPLICATION ACCEPTED BY.-------_- -- ------------ ---------------------- -- -�.- DATE---------- --------------- ,— --------- REVIEWEDBY------------------- ------------------------------------------------------------------ DATE------ ----- f. BUILDING PERMIT ISSUED------------------- _ = - - ------------------------ #%--DATE,-,:._�=- Alterations and/or recommendations:___ #!._. Y -,__. .�.-__ s ' / , e.-ems-- -------11/ { ----- kI7 -------------------------------- --------------------------------------- --------------------- � � r� ,�_ ---------- ---------------------------------------- - - - - ---------- i -- ------------------- - ---------------------- --------- ------------------------------------ t r FINAL INSPECTION BY ---------------...------- -------- Date f f ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:efton Ave,' --F"300 West Oak Street X124 Sycamore Street 205 West 9th Street A �Y " �-,- V.i .X S ` Stockton,California Lodi;CaliforniaMantteca,California Tracy,California i