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FOR OFFICE USE: z. APPLICATION FOR SANITATION PERMIT Permit No. ._. l`'?. 1... ---------------- r (Complete in Duplicate) Date Issued __-..--_-__------- ------__---__.__-__--...__-.-_.._._ This Permit Expires 1 Year From 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. JOB ADDRESS AND LOg� N--------• c��1 ' --f-------- ------------------------------------------------------------ } + f� ------------- Phone------------------------------------ --------Name--=---------•------- _ 11 ..._..� _/QL?C(.� -AddrO 4V--------- ----------------------------------------------------------- ess----------••------------------ Contractor's Name-=•:- .c _ . /` '"G Phone. `��o � Installation will serve: Residence [&,"Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other E] Number of living units: __1_-- Number of bedrooms _,Z.- Number of baths __— Lot size Z'o_,�-�- ___ ,Water Supply: Public system .El Community system ❑ Private 2"6epth to Water Table 4 ft. rY Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam &2/Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date_.------- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 6 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--------------------Material-----------------_----_.-________----.-----__--- ❑ No. of compartments-------------------------Sizedo ----------------------------Liquid depth--------------------------Capacity--------------------- Dispos Field: Distance from nearest well.-./0-0"Distance from founda ' n___r;�.0__f___.Distance to nearest lot line-- ------------- ...... in —: .. J 2 Number of lines________________ ___ ________Length of each line �__► ______..._.Wid,th of trench.____v _ ---------------- of filter material__ �/�Depth of filter material.._.,�X------------Tot al,.length______ ____________ ___------------ TypeD .�- -. T. Seep Pit: Distance to nearest well..�.QQ-_�____Distance fro foundatio _' "'-__.Dista ce to nearest lot line_-_- ________ r Number of pits-...___�---- -------Linin g rriaterial__ �/� Size: Diameter---- _.._._.i]epth....... ---------------- Cesspool: Distance from nearest well- ---------------Distance from foundation-----.-------------.Lining material..--------------------------------__. 'lt ❑ Size: Diameter------------------ -------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. r Privy,., Distance from nearest well. _ _ _ _ _________________________________ _.._....___-_Distance from nearest building___-______ ---_..__ ___ ___._______---. ❑ Distance to nearest lot line------- ---------------------------------- -------------------------------------------------------------------- A -------------------------- l Ai ----------------------------------------------------------------- `l Remodeiing and/or repairing (describe):__.___ 1------------ -- - -- -- - -- ----------------------------------------------------------------•--•----------------- -------------------------------------------------------------- - -- ----------------------� --------••----------------,----------------------------------------------- - ------------------------------------ ------------------ 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, a and regulations of the San Joaquin Local Health District. (Signed) ------------•--------/� ----- I l/ .-----� ��-�---------------------------------------(O ner nd/or Contractor) BY:----- \-- -----• -- --------------------------------------------------(Title)----- - ------I------ ---------- (Plot plan. showing size of-lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY.- / APPLICATION ACCEPTED BY----- ---��------- --- ------ —--------------------------------- DATE---- l/ V- REVIEWEDBY--------=------------------------- ------- -------------------------------------- DATE BUILDING PERMIT ISSUED-------------- ---------= DATE - -------- k----- ------------ -------- Alterations and/or recommendations* � -------------- ------ -- ---=----------- ----------•------ - ------•-•�` ��`�� Lt/ LJ C- --------------------------------------------------------------------------------------------------------------------------- - ------------ -------- . _- ------------------------------------------- -------------•---------- FINAL INSPECTION BY: �.:C -�-yam' Date _ `S� �'- ------------------- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street' 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.