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FbR OFFICE PSE: i � D APPLICATION FOR,.SANITATION PERMIT Per No. ...-....-.- , (Complete in Duplicate) Date issued --------------------------------------------------------- " "- -_ This Permit Ez ires I Year From Date Issued "-------- ----------- ---- ------- ----- ---- t 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. k " ---------------------------------------------------------- JOB __ ________________________________ a JOB ADDRESS AND LOCATION-------------------------------------�-r--- ---- - .Name------------ft---b-6r-/_' _ ... 1_A92-17---- ----•------------------- =------ --------------------------- Phone------------_---- ----------------- Owner's Address----------•-------------------------------------------------- --------------------•----------� �------ _.. .... l tPhone-10. Contractor's Name - 1 p� ' ' - 12_ , Installation will serve: Residence .Apartment House Cl ' Commercial ❑ Trailerr Court [I Motel s❑ Other E] ' Number of living units: Number of bedrooms__ Number of baths --- -_ Lot size _ -.��----------------- Water Supply: Public system ElCommunity system El -Private/14 Depth to Water Table - 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandyy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�� Hardpan ❑ Previous Application Made: (if yes,date__.;-.-----,--------)"No ❑ New Construction: Yes ❑ FHA/VA: Yes ❑ No*-.1, TYPE OF INSTALLATION AND SPECIFICATIONS: r(No septic tank or-cesspool permitted if public sewer is available within 200 feet.) 5 is T i i• 'i�tance from nearest well___--------------Distance from foundation.--_--.------_-----Material.---_____-_------_-.--_--------.---------------. No. of compartments-------------------------Size------------------------------•-Liquid depth--.---------------------- Capacity 4 i 1.D = . ._ t lot line_____ --------- � os eld: Distance from nearest well-911V------Distance from foundation__ : Number of lines------ I----------: Length of each line------ r Width of trench �- Type of filter material- �� ____- of filter material___-_�; r�-Total length_.�------ -..�-- --------•-•, C 6`epaqi Distance to nearest well __c�._ .___ .__ Distance fpm foundation____ ____�./-.Distance to nearest lot line_, -��- Number of its - --Lining material------ d �:-A.Size: Diameter----- .'�---..Depth------- e_-c --------------• Cesspool: Diitance from nearest well--------------_Distance from foundation-'-___:._'.=___r_Lining material------------------------------------- 7� ❑ � Size: Diameter------------------------------ -------Depth------ -l--------•------------------------Liquid Capacity-------------------------_-gals. ! Privy: Distance from nearest well_________._--:- ..---...--Distance from nearest building-------------------- ------------------ . r a M ..,F ---- ------------------------------------- ❑ Distance to nearest plot line--' --------- --------------------- --------- Remodelingand/or repairing (describe):-•------- ---- - - -------------- r - . ------f -- --- ------------- J ----------------------•--------------- •^^� ----___________________________________________________________________ ______________-------------__-------__-----_--------- ___ ------------ I hereby certify that'l have prepared +his application and that the work will be done in accordance with San Joaquin Coull+y ordinances, S+ )laws-.,and rules a d regulations of the San Join Local Health District. t . � e �. ^ ------------------------------{L�vMIFIFErfw Contractor) ori �-------- _ - �� .- ------�'� t`-h- ------------ -----•--------------•- (Signed)- ---- ---�; + ✓ --(Title)------------------------------ ----------------------------- By:---•--.:------------------------------------------ ------------:----------------- ----------- (Plot plan, showing size of lot, location of system in relation o wells, buildings c., c rrbe_placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----�------- ------------------- ------------------- DATE l� REVIEWEDBY------------------------ i D E ---------------------------....- BUILDINGPERMIT,.ISSUED---------------------------------------- •------------------------ DATE.----------------------------------------------------------- Altera+ions and/or recommendations:------------------- --="---=---------------------• ---------------... -------- -------------------- -------- .. ---- . ----------------•-- -- - ----------------------_.•-----------------------..-.. . ----------- ,.r.-�•--�`' ='------ - ---• - -- -------- --- ----- -. -------- --------•----------------------------------------------- ------- ------------------------ ---------------- - ------------------- -----=------------ 7 Rata-----------/ --- --------------------------------------- FINAL INSPECTION�BY:. 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 Er-9 REviaeD 9.59 r.P.GO.2-6.60