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FOR OF U --- - ------ --- _______________ ___________________________ APPLICATION FOR SANITATION PERMIT Permit No. ..... ._ . --------------------------------------------------- ----- (Complete in Duplicate) L ,y Date Issued .........-. �_�� ----------- --------- --------------- p' m Date Issued -__.��...-_.--.._- This Permit Expires 1 Year,.Frta,,,., 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 LOCATION-__-- s / ----------c�.- ------f'1.��/�....... T....----�✓f/��--- i I Owner's Name--------- - = •-------- £��A11;&�.<1&--— ------- ------------ Phone--------------------•--------. ?fir `-----------•--------------------- t Address = •---- -----•------------ Contractor's Name----------- !�� •-/4� f��f�l X5'6 --I�__f4 ,cis �77t: L--...... Phone G O7. Installation will serve: Residence)v Apartment House•❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms JTr_.. Number of baths _-1-. Lot size ._�.Sr-�,�,�Q--------------------------.---_ Water Supply: Public system Community system ❑�'Prvate ❑F Dep4h.to Water Table loft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑` Sandy Loam❑, Clay Imam ❑ Clay ❑ Adob_g-K Hardpan ❑ Previous Application Made: (If yes,date--__--------------=y. Nox New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,m... . . ,. (No septic tank or-cesspool permitted if public sewer is available within 200 feet.) AvtioT'�k: aDistance from foundation-------------------.Material--------------------- --------------------------. �I No. of compartmentst weH---- -----+--------------------Size------•---=----•-- ----------Liquid depth--------------------------Capacity----------------------- - - i DisposPI Id: Distance from nearest well__ - Lt�'':.Distance from foundation.-�Q.-�........Distance to nearest lot line-----S. Number of lines---------./----------- -----Y°Length of eack ine--- ---- Width of trench.-_..2 - ------------- Type of fitter of filter.material-----�Q---r--_.-Total length___..��...................1.- Seepa I, jit: Distance to nearest well--- -_Distance fr9q foursation_- Q-_...._-- stake to nearest lot line�..�.___-- ! Linin # Diameter--- - -----------Depth- �`----__-___. .Number of pits--..---(._--..----- F " w ` Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.-- ❑ Size: Diameter--------------------------------------Depth-------------------- ------------------------------Liquid Capacity----------------------------gals. Distance from st Privy: Distance to nearest lot line l _-_-___._-----------------------------------^ Distance from nearest building_,___.. _p,_ --..-.----__-_-_-.---_.-. � s Remodeling and/or repairing (describe):- __ __ -------I- -- -- -- ---- ------�__.-1-4------- ------------� ---•-------- -------------------------- ` - } f__: -- ---------------------- - - - 1 ecertify that I have prepared this application an re6y d that the work will be done in accordance with San Joaquin County ordinances, State la , and es and ;gulati ns of the San Joaquin Local Health District. i (Signed) �- ----------------- -_----_-___ Owner and/or Contractor By:---------------------------------------------------------- _- .�-- - _ itle]..... ...... . -- ........... (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. c n be placed on reverse side). • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- DATE----------------,4144 --------- REVIEWED BY------------------------------------- q - DATE---------�---------------- - BUILDINGPERMIT ISSUED-----_------------------- ----------------- -------------------•----------•-------------------- DATE-------------------------- ---------------------------------- Alterationsand/or recommendations----------- ------------------------------------------•----------------------------------------••-•----•---------------..-..---------------------•-•---4------ s-f YJ __k- --------4_f /----------Vi t----�---- t r - ------ -------------------- -- --•----------..... .� �- � � ----- . . - ----- -------------------- FINALINSPECTION BY-------------------------------------------------- -- ---------• Date----- ------- --•-••------------• ----------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6•9 REVISED 0.99 F.P.00.7M 6.60