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FOR OFFICE USE: ---------------- -------------- -------------- APPLICATION FOR, SANITATION PERMIT Permit No. ---------------- . ............. -------------------- (Complete in Duplicate) Date Issued Y�ZF�Pjg� ---------------------------------------------�M�ww��M�m I This Permit Expires I Year From Date Issued Application tion 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 AINA LOCA WN......5...I-km......................... ..... .................................... Owner's Name........tt..... ... ... ........ ------------- Phone.................................... ------------------------------------------ Address --- -------------F.............. -- --------------------- ...............---------------------------------------------- Contractor's Name-----...........S, .. . .... ...... ........ .................................. Phone----------------------------------- Installation will serve: Residence F] Apartment House E] Commercial CT Trailer Court C] Motel 0 Other [I Number of living units: _....... Number of bedrooms -------- Number. baths ---1?�Iot size _____________________1111....-. --------------*M---------- Water Supply Public system [I Community system [], PrivateODepth tq Water Table ........ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Er Clay Loam E] Clay [] Adobe 0 Hardpan 0 Previous Application Made: (If yes,date----------- --------) No r-1 New Construction: Yes E] No E] FHA/VA: Yes F1 No M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet;}....... or 10 - -------- Septic nk: Distance from nearest well____` p._...Distance from foundation____.?4!------ - Material--- ----- No. of compartments_..____ Liquid depth___-_- -------Capacity.15P.O.. e.49------- Distance to nearest lot line.- _....... Dis Field: Distance from nearest well__.10 ... Distance from foundation. _.__rDistance Number of lines-........ ____________Length of eaA, lin ---.Width of trench-----Zl�-!-------------------- Vp PType of filter mat ;.00 ------- Depth of filter material......11-m---------Total length... ..........•------ erial.- C . Seepage Pit: Distance to nearest well_---.---------m-------Distane_ from foundation-m.......m..........Distance to nearest lot line__.__._.._....... 6 r_1 Number of pits_..m-----------------Lining material--_ Size: Diameter__..--_..-_.. .__ -___Depth--.--.--------------------m------ Cesspool: Distance from nearest well-----------m-----Distance from foundation-------............Lining material-_--. -__-________-._ --..__m........ El Size: Diameter------------------ -------------------Depth-_--------mm------m.....I------------------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------m_----------m------Distance from nearest building-___..._______-__-__._.______._________._. "1i ❑ Distance uilding---------_-m----------- Distance to nearest lot line----------------------------m------------------ .............. .......•-----------------------•-------•--------------------------- 4 Remodelingand/or repairing (describe):------------------------------ ---------------------------------------•--. .....-------------=-•-----•--------------• --------------......... M-------------M------M-----------------M--------M-------------M-------- ...........M----M.......-----------------------------------M---M............M..............M-----M---------------- 9 .M-------------M----MM ---------M---M---------M-M.........................M...M---—.................................................M----------------------------M...........................M...M-M-------- RO --------------M---------------------------M-----------------M_M_-----M---M------M------M...........-------M-------------...M---M............M......M---------------MM............M-----M---...M----------M---_ I hereby ce i that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St nel s, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- ...........m----------- --------- ------------- -- _--iow"69 and/or Contractor) 'a, -----_--------------------11------- (Title)--------------------------------------M------------------------ By:....... -- ---------- (Plot plan, showing size of lot, location of s stem in re ation to wells, buildings, etc., can be placed on reverse side). A 101 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------------------------------------------- DATE----. ---•------------------------- REVIEWED ----------M......M---------- REVIEWEDBY----------------------------------------------•-- ------------------MM--------------_M--------------------------------.... DATE---------------------------------------m..................MM BUILDINGPERMIT ISSUED--------------------------------------------------------M------------M-----------------------------_ DATE-------------------......-- 7------------------ Alterationsand/or recommendations----------------------•---- .................................. .................................................M......................................... ........................................................M...........---------- ..........................................M............M............................................................................. ----------I---•----•---------•----•--------------------------------•--------------------------------------M........---------------------------------M................................M.....................M_..... -----•---------•- ......M------------------------------------------------------------------...M-----------------------------------------------M................ ...............................M..................... ----------- --------------- ---------------------•----------•------------------------------ ...................M----------M--------------------------------- ------------1• --------------M..... Z" Date.... -;P ------------------------- --------- FINAL INSPECTION - ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 1.24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C13.